Healthcare Provider Details

I. General information

NPI: 1639004476
Provider Name (Legal Business Name): JENNIFER STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9256 BENDIX RD STE 200B
COLUMBIA MD
21045-1848
US

IV. Provider business mailing address

616 PLYMOUTH RD # 2
BALTIMORE MD
21229-2212
US

V. Phone/Fax

Practice location:
  • Phone: 443-648-9095
  • Fax:
Mailing address:
  • Phone: 410-916-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM07175
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: