Provider Demographics
NPI:1912357112
Name:AUSTAD, JESIKA DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESIKA
Middle Name:DAWN
Last Name:AUSTAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 N WAHSATCH AVE # 311
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6941
Mailing Address - Country:US
Mailing Address - Phone:651-800-1814
Mailing Address - Fax:
Practice Address - Street 1:325 2ND ST STE T
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9217
Practice Address - Country:US
Practice Address - Phone:651-800-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005522103TC0700X
MNLP6561103TC0700X
MN6561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical