Provider Demographics
NPI:1689827354
Name:KRICK, JESS ALAN (CMT)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:ALAN
Last Name:KRICK
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 RODRIGUES AVE
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:425-614-7671
Mailing Address - Fax:
Practice Address - Street 1:163 RODRIGUES AVE
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5715
Practice Address - Country:US
Practice Address - Phone:425-614-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist