Provider Demographics
NPI:1154845683
Name:STAGE BY STAIGE
Entity Type:Organization
Organization Name:STAGE BY STAIGE
Other - Org Name:STAGE BY STAIGE- JAIL
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNSELOR, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:STAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LADC
Authorized Official - Phone:507-216-5151
Mailing Address - Street 1:11 E VETERANS MEMORIAL HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1716
Mailing Address - Country:US
Mailing Address - Phone:507-216-5151
Mailing Address - Fax:507-634-7120
Practice Address - Street 1:2500 ALEXANDER ST SW
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4721
Practice Address - Country:US
Practice Address - Phone:507-216-5151
Practice Address - Fax:507-634-7120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAGE BY STAIGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-26
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304332101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty