Provider Demographics
NPI:1306232699
Name:BRITTENHAM, JENNIFER J (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:BRITTENHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W 24TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8877
Mailing Address - Country:US
Mailing Address - Phone:928-328-1975
Mailing Address - Fax:928-328-1720
Practice Address - Street 1:2140 W 24TH ST STE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8877
Practice Address - Country:US
Practice Address - Phone:928-328-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist