Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3122 | CO |
N | 103T00000X | Psychologist | 3122 | CO |
Y | 103G00000X | Clinical Psychologist | 0003122 | CO |
Y | 103TC0700X | Clinical Psychologist | 0003122 | CO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0003122 | CO |
NPI | 1093001182 |
---|---|
Provider Name | Dr. Jessica A Stone |
First Address | Fruita, CO 81521-2510 |
Second Address | Fruita, CO 81521-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 23/09/2021 |