Provider Demographics
NPI:1497627780
Name:LACROIX, JENNIFER JOANNE
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JOANNE
Last Name:LACROIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 CLAUDIA CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4805
Mailing Address - Country:US
Mailing Address - Phone:562-572-4703
Mailing Address - Fax:
Practice Address - Street 1:1401 W VALENCIA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3998
Practice Address - Country:US
Practice Address - Phone:714-447-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool