Provider Demographics
NPI:1558572594
Name:STUMPE, JESSICA M (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:STUMPE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N KANSAS ST STE 3054
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3124
Mailing Address - Country:US
Mailing Address - Phone:316-293-2611
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:1001 N MINNEAPOLIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3127
Practice Address - Country:US
Practice Address - Phone:316-293-2647
Practice Address - Fax:855-476-0305
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical