Provider Demographics
NPI:1285084400
Name:KINCER, JACQUELINE (IBCLC, COMC, ISE)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KINCER
Suffix:
Gender:F
Credentials:IBCLC, COMC, ISE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 N 33RD PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3316
Mailing Address - Country:US
Mailing Address - Phone:425-985-5096
Mailing Address - Fax:
Practice Address - Street 1:4500 N 32ND ST STE 201D
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3397
Practice Address - Country:US
Practice Address - Phone:602-842-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
L-96282174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist