Individual
JESSICA KELLI LEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5667 MONTEZUMA RD APT F, SAN DIEGO, CA 92115-2319
(408) 348-9532
Mailing address
3080 E CHERRY ST # B302, SPRINGFIELD, MO 65802-2625
(408) 348-9532
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/23/2020
Last updated
07/23/2021
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