Provider Demographics
NPI:1336122910
Name:FROST, JENNY (LAC)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:FROST
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 1:113 N MASON ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2724
Mailing Address - Country:US
Mailing Address - Phone:805-481-1035
Mailing Address - Fax:
Practice Address - Street 1:260 STATION WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3359
Practice Address - Country:US
Practice Address - Phone:805-481-3442
Practice Address - Fax:805-481-3443
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10087171100000X
CAAC100-87171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty