Provider Demographics
NPI:1669701793
Name:STEMMLER, CHRISTINA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:STEMMLER
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 1:2420 N COLISEUM BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-3139
Mailing Address - Country:US
Mailing Address - Phone:260-782-1945
Mailing Address - Fax:260-599-6745
Practice Address - Street 1:2420 N COLISEUM BLVD STE 105
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-3139
Practice Address - Country:US
Practice Address - Phone:260-782-1945
Practice Address - Fax:260-599-6745
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042378A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200972320Medicaid
IN148730GMedicare PIN