Provider Demographics
NPI:1992306492
Name:TATSCH-GLEASON, JENNIFER SUZANNE (LSA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:TATSCH-GLEASON
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 BLUEBANNET LN.
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2708
Mailing Address - Country:US
Mailing Address - Phone:210-748-8480
Mailing Address - Fax:
Practice Address - Street 1:7700 FLOYD CURL DR.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3902
Practice Address - Country:US
Practice Address - Phone:210-575-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant