Provider Demographics
NPI:1073708764
Name:STEBBINS, JENNIFER LOUISE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:STEBBINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4644
Mailing Address - Country:US
Mailing Address - Phone:206-909-3498
Mailing Address - Fax:
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4452
Practice Address - Country:US
Practice Address - Phone:406-471-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health