Provider Demographics
NPI:1346825460
Name:DR. JESIKA AUSTAD, LLC
Entity Type:Organization
Organization Name:DR. JESIKA AUSTAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-800-1814
Mailing Address - Street 1:2316 N WAHSATCH AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 2ND ST STE T
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9217
Practice Address - Country:US
Practice Address - Phone:651-800-1814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty