| NPI | 1821514001 |
|---|---|
| Former Name | STEPHANIE ANNE JERNIGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38280) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 38280) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2022-06-20 |