Provider Demographics
NPI:1275992448
Name:STICH, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STICH
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 1:3406 W SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7923
Mailing Address - Country:US
Mailing Address - Phone:904-710-1547
Mailing Address - Fax:
Practice Address - Street 1:3406 W SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7923
Practice Address - Country:US
Practice Address - Phone:904-710-1547
Practice Address - Fax:813-512-2734
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst