Provider Demographics
NPI:1609368497
Name:DAGGETT, JENNIFER FRANCES (QMHS)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:FRANCES
Last Name:DAGGETT
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 N RIDGE RD E STE D
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3359
Mailing Address - Country:US
Mailing Address - Phone:440-324-5701
Mailing Address - Fax:440-277-0459
Practice Address - Street 1:1865 N RIDGE RD E STE D
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3359
Practice Address - Country:US
Practice Address - Phone:440-324-5701
Practice Address - Fax:440-277-0459
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty