Provider Demographics
NPI:1437459344
Name:BELKNAP, JESSICA ANNE (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:BELKNAP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LUEHRS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8065 APTOS ST
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-331-9748
Mailing Address - Fax:831-685-0108
Practice Address - Street 1:8065 APTOS ST
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-331-9748
Practice Address - Fax:831-685-0108
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13905171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist