Individual
STACY A DESJARDINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NMT, CMT
Contact information
Practice address
4000 MONTGOMERY DR, SUITE L-4, SANTA ROSA, CA 95405-5281
(707) 953-2811
Mailing address
4000 MONTGOMERY DR, SUITE L-4, SANTA ROSA, CA 95405
(707) 953-2811
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14021
CA
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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