Provider Demographics
NPI:1952793895
Name:STEPHENSON, JACQUELINE JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JEAN
Last Name:STEPHENSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:JEAN
Other - Last Name:SPEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2952 TECHNOLOGY BLVD W STE 218
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4145
Mailing Address - Country:US
Mailing Address - Phone:406-414-6607
Mailing Address - Fax:406-604-9061
Practice Address - Street 1:2952 TECHNOLOGY BLVD W STE 218
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4145
Practice Address - Country:US
Practice Address - Phone:406-414-6607
Practice Address - Fax:406-604-9061
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO4080208600000X
MTMED-PHYS-LIC-113907208600000X
PAOS019754208600000X
TXS3751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery