Provider Demographics
NPI:1770501959
Name:ANDERS, JENNIFER LYN (LIC AC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYN
Last Name:ANDERS
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 CHISWICK RD APT 202
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5305
Mailing Address - Country:US
Mailing Address - Phone:617-783-0975
Mailing Address - Fax:
Practice Address - Street 1:214 MARKET ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1946
Practice Address - Country:US
Practice Address - Phone:617-480-1998
Practice Address - Fax:617-787-5045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist