Provider Demographics
NPI:1033232400
Name:STEVENS, JILL ALISON (LAC, DILPOM)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ALISON
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LAC, DILPOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 CHRISTIE AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1930
Mailing Address - Country:US
Mailing Address - Phone:415-310-6906
Mailing Address - Fax:866-353-0473
Practice Address - Street 1:5901 CHRISTIE AVE
Practice Address - Street 2:STE 304
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1930
Practice Address - Country:US
Practice Address - Phone:415-310-6906
Practice Address - Fax:866-353-0473
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11577171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist