Provider Demographics
NPI:1558543181
Name:SCHWARZ, JESSICA E (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:SCHWARZ
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 1:514 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4646
Mailing Address - Country:US
Mailing Address - Phone:206-781-5128
Mailing Address - Fax:
Practice Address - Street 1:514 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4646
Practice Address - Country:US
Practice Address - Phone:206-781-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17171100000X
WAAC00002657171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist