Provider Demographics
NPI:1093179566
Name:STAGGS, JENNIFER (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STAGGS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 RAMAR RD STE B
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7117
Mailing Address - Country:US
Mailing Address - Phone:928-299-2678
Mailing Address - Fax:928-350-6405
Practice Address - Street 1:2755 SILVER CREEK RD STE 203
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8347
Practice Address - Country:US
Practice Address - Phone:928-299-2678
Practice Address - Fax:928-350-6405
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-14148104100000X
AZLCSW-168201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker