Provider Demographics
NPI:1659439628
Name:STEMBEL, JESSICA ALYCE (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ALYCE
Last Name:STEMBEL
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ALYCE
Other - Last Name:BISSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:8320 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6066
Mailing Address - Country:US
Mailing Address - Phone:317-494-0739
Mailing Address - Fax:
Practice Address - Street 1:8320 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6066
Practice Address - Country:US
Practice Address - Phone:317-494-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042096103TC2200X
IN20042096A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200845530Medicaid
IN145590V4Medicare PIN