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General NPI Number Information
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NPI Number | 1801389382
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Entity Type | Individual
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Provider Name | JENNIFER ANN STUBBLEFIELD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 14949 62ND ST N
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City | STILLWATER
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State | MN
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Zip | 55082-6102
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Country | US
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Telephone | 651-430-6483
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Fax |
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Provider Business Mailing Address
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Address Line | 14949 62ND ST N
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City | STILLWATER
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State | MN
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Zip | 55082-6102
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Country | US
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Telephone | 651-430-6483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304423
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3828
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License Number State | MN
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