Provider Demographics
NPI:1578280210
Name:STUTTLER, JAY J
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:J
Last Name:STUTTLER
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 1:817 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-4033
Mailing Address - Country:US
Mailing Address - Phone:505-448-6112
Mailing Address - Fax:
Practice Address - Street 1:817 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-4033
Practice Address - Country:US
Practice Address - Phone:505-448-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician