Provider Demographics
NPI:1073653895
Name:LANDERS, JENNIFER HELEN (CMT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:HELEN
Last Name:LANDERS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 SCHMUCKLY DR APT 9
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5368
Mailing Address - Country:US
Mailing Address - Phone:916-640-7763
Mailing Address - Fax:
Practice Address - Street 1:9198 GREENBACK LN STE 208
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-5901
Practice Address - Country:US
Practice Address - Phone:916-640-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA329080174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist