Provider Demographics
NPI:1578959136
Name:LECHTENBERG, JENNIFER (AT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LECHTENBERG
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 E SHARI ST
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5900
Mailing Address - Country:US
Mailing Address - Phone:480-766-1418
Mailing Address - Fax:
Practice Address - Street 1:1289 E SHARI ST
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-5900
Practice Address - Country:US
Practice Address - Phone:480-766-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer