Provider Demographics
NPI:1194290692
Name:JAEGER, ADELLA JENNY (LCSW)
Entity type:Individual
Prefix:
First Name:ADELLA
Middle Name:JENNY
Last Name:JAEGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 WHITSETT AVE # 191
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1615
Mailing Address - Country:US
Mailing Address - Phone:747-205-0896
Mailing Address - Fax:702-472-8909
Practice Address - Street 1:2520 SAINT ROSE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7784
Practice Address - Country:US
Practice Address - Phone:844-933-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA858191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical