Provider Demographics
NPI:1740596576
Name:STAYTON, LINDSAY GRACE (LICSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:GRACE
Last Name:STAYTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7943
Mailing Address - Country:US
Mailing Address - Phone:402-207-6533
Mailing Address - Fax:402-614-6174
Practice Address - Street 1:3308 SAMSON WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3234
Practice Address - Country:US
Practice Address - Phone:402-717-7681
Practice Address - Fax:402-291-8806
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical