Provider Demographics
NPI:1255046553
Name:JEFFRIES, STELLA M
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 N INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-1036
Mailing Address - Country:US
Mailing Address - Phone:765-398-0151
Mailing Address - Fax:
Practice Address - Street 1:813 N INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1036
Practice Address - Country:US
Practice Address - Phone:765-398-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist