Healthcare Provider Details

I. General information

NPI: 1538781398
Provider Name (Legal Business Name): JESSICA ELIZABETH STUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CIRBY HILLS DR
ROSEVILLE CA
95678-4360
US

IV. Provider business mailing address

101 CIRBY HILLS DR
ROSEVILLE CA
95678-4360
US

V. Phone/Fax

Practice location:
  • Phone: 916-787-8860
  • Fax:
Mailing address:
  • Phone: 916-787-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: