Provider Demographics
NPI:1053975797
Name:STILLMAN, JESSICA NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NICOLE
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 16TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2802
Mailing Address - Country:US
Mailing Address - Phone:301-562-7200
Mailing Address - Fax:
Practice Address - Street 1:10750 COLUMBIA PIKE STE 600
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4459
Practice Address - Country:US
Practice Address - Phone:301-562-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006163103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist