MEDICARE: JESSICA STIER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	125.068539	IL
2	2084P0800X	Psychiatry Physician	036150720	IL

General Provider Information

NPI Number	:	1447608492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA STIER M.D.

Provider Business Mailing Address
First Line	:	1643 N ALPINE RD STE 104-528
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1462
Country	:	US
Telephone Number	:	815-324-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1643 N ALPINE RD STE 104-528
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1462
Country	:	US
Telephone Number	:	815-324-0346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/15/2020

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