Healthcare Provider Details

I. General information

NPI: 1174738298
Provider Name (Legal Business Name): JARROD S STEFFAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 EAST HARRY
WICHITA KS
67207
US

IV. Provider business mailing address

PO BOX 780359
WICHITA KS
67207-0359
US

V. Phone/Fax

Practice location:
  • Phone: 316-300-9708
  • Fax: 877-310-6013
Mailing address:
  • Phone: 316-300-9708
  • Fax: 877-310-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1677
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: