Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 174N00000X | Lactation Consultant | L-153818 | MA |
NPI | 1275181950 |
---|---|
Provider Name | Ms. Alexis Jette Jette |
First Address | Lincoln, MA 01773-5115 |
Second Address | Lincoln, MA 01773-5115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 10/09/2021 |