Healthcare Provider Details

I. General information

NPI: 1558256149
Provider Name (Legal Business Name): JENNIFER LYNN STAATS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN PARRY

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N MILFORD DR
FRANKLIN IN
46131-7308
US

IV. Provider business mailing address

11 TRAFALGAR SQ
TRAFALGAR IN
46181-9515
US

V. Phone/Fax

Practice location:
  • Phone: 317-739-4848
  • Fax: 317-346-4062
Mailing address:
  • Phone: 317-648-7169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99131022A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: