Provider Demographics
NPI:1790015964
Name:LEEPER, JENNIFER A (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LEEPER
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 1:2090 BROADWAY ST APT 604
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1510
Mailing Address - Country:US
Mailing Address - Phone:415-987-8703
Mailing Address - Fax:
Practice Address - Street 1:1863 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4307
Practice Address - Country:US
Practice Address - Phone:415-987-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist