Provider Demographics
NPI:1811211535
Name:STURGIS, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STURGIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PURNELL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-1351
Mailing Address - Country:US
Mailing Address - Phone:443-783-6221
Mailing Address - Fax:
Practice Address - Street 1:6040 PUBLIC LANDING ROAD
Practice Address - Street 2:WORCESTER COUNTY HEALTH DEPARTMENT
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863
Practice Address - Country:US
Practice Address - Phone:410-632-1100
Practice Address - Fax:410-632-4933
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MD705371101Medicaid