Provider Demographics
NPI:1194034843
Name:MANN, JESSICA (LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 S ASH AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6836
Mailing Address - Country:US
Mailing Address - Phone:480-455-9899
Mailing Address - Fax:
Practice Address - Street 1:5005 S ASH AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6836
Practice Address - Country:US
Practice Address - Phone:480-455-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist