Individual
JESSICA J TAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
1513 S 700 E, KAYSVILLE, UT 84037-3000
(801) 864-5094
Mailing address
1513 S 700 E, KAYSVILLE, UT 84037-3000
(801) 864-5094
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
L-110720
—
Other
Enumeration date
11/17/2021
Last updated
11/17/2021
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