MEDICARE: ANDREA STAGGER LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1910-M	AR

General Provider Information

NPI Number	:	1356567515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA STAGGER LMSW

Provider Business Mailing Address
First Line	:	2803 DORSET DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-4212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 DORSET DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-4212
Country	:	US
Telephone Number	:	501-224-8807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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