Provider Demographics
NPI:1164992756
Name:CLELLAND, JESSICA (CMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CLELLAND
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 1:40820 WINCHESTER RD #2505
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:956-223-0625
Mailing Address - Fax:
Practice Address - Street 1:40820 WINCHESTER RD #2505
Practice Address - Street 2:SUITE 10
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:956-223-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93560225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist