Provider Demographics
NPI:1548664147
Name:DEAHL, JESSICA (LAC)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:DEAHL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7870
Mailing Address - Country:US
Mailing Address - Phone:520-373-0012
Mailing Address - Fax:
Practice Address - Street 1:1600 N TUCSON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3402
Practice Address - Country:US
Practice Address - Phone:520-373-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ933171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist