Provider Demographics
NPI:1720637028
Name:GLASPELL, JENNIFER (LEP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GLASPELL
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 ANGELROCK LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8253
Mailing Address - Country:US
Mailing Address - Phone:808-365-2354
Mailing Address - Fax:
Practice Address - Street 1:5345 ANGELROCK LOOP
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-8253
Practice Address - Country:US
Practice Address - Phone:808-365-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2915103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool