Provider Demographics
NPI:1740597863
Name:ISGITT, STEPHANIE BLAIR (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BLAIR
Last Name:ISGITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:BLAIR
Other - Last Name:BRUSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4821 MARBLEHEAD BAY DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-3411
Mailing Address - Country:US
Mailing Address - Phone:206-459-1591
Mailing Address - Fax:
Practice Address - Street 1:1601 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6322
Practice Address - Country:US
Practice Address - Phone:714-479-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical