Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 21873 | CA |
Y | 103T00000X | Psychologist | PSY 21873 | CA |
NPI | 1013187194 |
---|---|
Provider Name | Dr. Lori Ann Jespersen |
First Address | Cotati, CA 94931-6105 |
Second Address | Cotati, CA 94931-6105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 05/03/2008 |