Provider Demographics
NPI:1407997471
Name:STANLEY, JACQUELINE H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:H
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 STONERIDGE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7084
Mailing Address - Country:US
Mailing Address - Phone:406-599-2492
Mailing Address - Fax:
Practice Address - Street 1:1043 STONERIDGE DR STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7084
Practice Address - Country:US
Practice Address - Phone:406-599-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2584103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical