Provider Demographics
NPI:1558256149
Name:STAATS, JENNIFER LYNN (LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:STAATS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:PARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 TRAFALGAR SQ
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-9515
Mailing Address - Country:US
Mailing Address - Phone:317-648-7169
Mailing Address - Fax:
Practice Address - Street 1:55 N MILFORD DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7308
Practice Address - Country:US
Practice Address - Phone:317-739-4848
Practice Address - Fax:317-346-4062
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99131022A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker