Provider Demographics
NPI:1548778509
Name:SEBOK, JESSICA GRACE (CD, CLC, SBD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:SEBOK
Suffix:
Gender:F
Credentials:CD, CLC, SBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SILVER OAKS LN APT 5
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3770
Mailing Address - Country:US
Mailing Address - Phone:217-412-7632
Mailing Address - Fax:
Practice Address - Street 1:2 SILVER OAKS LN APT 5
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3770
Practice Address - Country:US
Practice Address - Phone:217-412-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2045-13OtherMADRIELLA DOULA CERTIFICATION