Provider Demographics
NPI:1427656198
Name:STAUFFER, JODI LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 WONDER WORLD DR STE 304-147
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6076
Mailing Address - Country:US
Mailing Address - Phone:830-431-6161
Mailing Address - Fax:
Practice Address - Street 1:2497 FM 1979
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666
Practice Address - Country:US
Practice Address - Phone:830-431-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW629811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX62981OtherLICENSED CLINICAL SOCIAL WORKER