Provider Demographics
NPI:1912415514
Name:STEDJE, JESSICA BRIANNE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BRIANNE
Last Name:STEDJE
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 1:8530 FM 2349
Mailing Address - Street 2:
Mailing Address - City:GRUVER
Mailing Address - State:TX
Mailing Address - Zip Code:79040-6020
Mailing Address - Country:US
Mailing Address - Phone:580-461-9998
Mailing Address - Fax:
Practice Address - Street 1:3247 NE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-5143
Practice Address - Country:US
Practice Address - Phone:580-338-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health