Provider Demographics
NPI:1801552120
Name:KLAMECKI, JUDITH (DACM, LAC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:KLAMECKI
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:KLAMECKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:200 7TH AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4670
Mailing Address - Country:US
Mailing Address - Phone:831-246-0177
Mailing Address - Fax:
Practice Address - Street 1:200 7TH AVE STE 135
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4670
Practice Address - Country:US
Practice Address - Phone:831-246-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist