Provider Demographics
NPI:1750446415
Name:JAGGI, MARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:JAGGI
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 1:3991 STATE HIGHWAY 414
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-9014
Mailing Address - Country:US
Mailing Address - Phone:307-786-2121
Mailing Address - Fax:
Practice Address - Street 1:3991 STATE HIGHWAY 414
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937-9014
Practice Address - Country:US
Practice Address - Phone:307-786-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical