Provider Demographics
NPI:1013187194
Name:JESPERSEN, LORI ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:JESPERSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-6105
Mailing Address - Country:US
Mailing Address - Phone:707-795-5754
Mailing Address - Fax:
Practice Address - Street 1:471 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-6105
Practice Address - Country:US
Practice Address - Phone:707-795-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21873103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist