Provider Demographics
NPI:1932760022
Name:MCISAAC, JENNIFER LYNN (HHP, CMT, CCMH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCISAAC
Suffix:
Gender:F
Credentials:HHP, CMT, CCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 BALBOA AVE STE 706
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2949
Mailing Address - Country:US
Mailing Address - Phone:619-889-9912
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 706
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2949
Practice Address - Country:US
Practice Address - Phone:619-889-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
CA7931225700000X
2003006141171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist