Provider Demographics
NPI:1639394687
Name:DAGGETT, BOBBI JO (CADAC #1034)
Entity Type:Individual
Prefix:MS
First Name:BOBBI
Middle Name:JO
Last Name:DAGGETT
Suffix:
Gender:F
Credentials:CADAC #1034
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 LA VIDA NUEVA DEL NORTE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-2660
Mailing Address - Country:US
Mailing Address - Phone:505-315-3789
Mailing Address - Fax:
Practice Address - Street 1:630 HAINES AVE. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-268-5611
Practice Address - Fax:505-268-5736
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)