Healthcare Provider Details

I. General information

NPI: 1114509817
Provider Name (Legal Business Name): JACOB MICHAEL STAMM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 S HAMILTON RD STE 200
COLUMBUS OH
43232-4382
US

IV. Provider business mailing address

4764 CHARRINGTON CIR
INDIANAPOLIS IN
46254-9671
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-0042
  • Fax:
Mailing address:
  • Phone: 765-546-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: