Provider Demographics
NPI:1386158277
Name:CROFTS, JESSICA E (LAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:CROFTS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:E
Other - Last Name:CROFTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JESSICA E VARGAS
Mailing Address - Street 1:54 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-4045
Mailing Address - Country:US
Mailing Address - Phone:303-330-1309
Mailing Address - Fax:
Practice Address - Street 1:54 LYONS RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516
Practice Address - Country:US
Practice Address - Phone:303-330-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT717171100000X
NY005955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist