Provider Demographics
NPI:1528778198
Name:THE VILLAGE - SOUTH JERSEY BREASTFEEDING & WELLNESS
Entity type:Organization
Organization Name:THE VILLAGE - SOUTH JERSEY BREASTFEEDING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:856-942-4305
Mailing Address - Street 1:915 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1900
Mailing Address - Country:US
Mailing Address - Phone:856-942-4305
Mailing Address - Fax:
Practice Address - Street 1:915 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1900
Practice Address - Country:US
Practice Address - Phone:856-942-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty