Provider Demographics
NPI:1831315464
Name:STEGMAN, JERILYNN GAYE (MA, RAS)
Entity Type:Individual
Prefix:
First Name:JERILYNN
Middle Name:GAYE
Last Name:STEGMAN
Suffix:
Gender:F
Credentials:MA, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SERENE CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3039
Mailing Address - Country:US
Mailing Address - Phone:925-363-5000
Mailing Address - Fax:
Practice Address - Street 1:3024 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2588
Practice Address - Country:US
Practice Address - Phone:925-363-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS0501030742101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS0501030742OtherRAS