Provider Demographics
NPI:1497949986
Name:GAMER, JENNY LEA (LAC)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:LEA
Last Name:GAMER
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 1:4025 KENYON BLVD
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-8049
Mailing Address - Country:US
Mailing Address - Phone:507-990-5981
Mailing Address - Fax:
Practice Address - Street 1:205 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2014
Practice Address - Country:US
Practice Address - Phone:507-645-8242
Practice Address - Fax:507-645-8242
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1260171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist