Provider Demographics
NPI:1295001303
Name:STITELEY, JESSICA RAE (MFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:STITELEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2925 MONDOVI RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6141
Mailing Address - Country:US
Mailing Address - Phone:715-832-0238
Mailing Address - Fax:715-832-0771
Practice Address - Street 1:2925 MONDOVI RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6141
Practice Address - Country:US
Practice Address - Phone:715-832-0238
Practice Address - Fax:715-832-0771
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI906-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist