Provider Demographics
NPI:1437580826
Name:JAGGER, TINA L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:JAGGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N CHAUNCEY STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-2002
Mailing Address - Country:US
Mailing Address - Phone:260-244-6300
Mailing Address - Fax:
Practice Address - Street 1:104 N CHAUNCEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-2002
Practice Address - Country:US
Practice Address - Phone:260-244-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006946A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical