Provider Demographics
NPI:1285008391
Name:STAHNKE, JASON GREGORY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:GREGORY
Last Name:STAHNKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5360
Mailing Address - Country:US
Mailing Address - Phone:720-448-7820
Mailing Address - Fax:
Practice Address - Street 1:6105 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5361
Practice Address - Country:US
Practice Address - Phone:720-448-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099239041041C0700X
CO00099201761041C0700X
MO20150191671041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical