Provider Demographics
NPI:1881943223
Name:ROSENKVIST, JESSICA CHRISTINE OETTING (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHRISTINE OETTING
Last Name:ROSENKVIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CHRISTINE
Other - Last Name:OETTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:WASHINGTON UNIVERSITY DEPARTMENT OF PSYCHIATRY
Mailing Address - Street 2:CAMPUS BOX 8134
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-2462
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTON UNIVERSITY DEPARTMENT OF PSYCHIATRY
Practice Address - Street 2:CAMPUS BOX 8134
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-362-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120209712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry