Provider Demographics
NPI:1063857837
Name:GIESE-GARDNER, JESSICA (LAC, MTCM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GIESE-GARDNER
Suffix:
Gender:F
Credentials:LAC, MTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E CAMPBELL AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2139
Mailing Address - Country:US
Mailing Address - Phone:408-628-1888
Mailing Address - Fax:408-724-8999
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2139
Practice Address - Country:US
Practice Address - Phone:408-628-1888
Practice Address - Fax:408-724-8999
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist