Provider Demographics
NPI:1811189871
Name:STERN, JESSICA RAE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 3RD ST E
Mailing Address - Street 2:AWARE, INC
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4573
Mailing Address - Country:US
Mailing Address - Phone:406-890-8725
Mailing Address - Fax:
Practice Address - Street 1:20 3RD ST E
Practice Address - Street 2:AWARE, INC
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4573
Practice Address - Country:US
Practice Address - Phone:406-890-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT183152084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry