Provider Demographics
NPI:1124351028
Name:CLELAND, JENNIFER LEE (ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:CLELAND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 JANES WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6666
Mailing Address - Country:US
Mailing Address - Phone:540-664-6384
Mailing Address - Fax:
Practice Address - Street 1:1420 AUSTIN BLUFFS PKWY
Practice Address - Street 2:UCCS SPORTS MEDICINE DEPT.
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3733
Practice Address - Country:US
Practice Address - Phone:719-255-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer