Provider Demographics
NPI:1528136306
Name:CRISSMAN, JENNIFER (MS LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CRISSMAN
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20501
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94620-0501
Mailing Address - Country:US
Mailing Address - Phone:510-938-2600
Mailing Address - Fax:
Practice Address - Street 1:660 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3557
Practice Address - Country:US
Practice Address - Phone:510-938-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8897171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist