Provider Demographics
NPI:1235845199
Name:STENSTROM, JESSICA LAUREN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:STENSTROM
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 1:22915 COBB HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20117-3025
Mailing Address - Country:US
Mailing Address - Phone:540-336-5870
Mailing Address - Fax:
Practice Address - Street 1:22915 COBB HOUSE RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:VA
Practice Address - Zip Code:20117-3025
Practice Address - Country:US
Practice Address - Phone:540-336-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator