Healthcare Provider Details

I. General information

NPI: 1659439628
Provider Name (Legal Business Name): JESSICA ALYCE STEMBEL PSY.D., HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ALYCE BISSEY PSYD

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 MADISON AVE
INDIANAPOLIS IN
46227-6066
US

IV. Provider business mailing address

8320 MADISON AVE
INDIANAPOLIS IN
46227-6066
US

V. Phone/Fax

Practice location:
  • Phone: 317-494-0739
  • Fax:
Mailing address:
  • Phone: 317-494-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20042096
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042096A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: