Provider Demographics
NPI:1861628489
Name:STAGNER, MOLLY MCMAHON (LISW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MCMAHON
Last Name:STAGNER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1200 VALLEY WEST DR STE 304-11
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1903
Mailing Address - Country:US
Mailing Address - Phone:515-310-1069
Mailing Address - Fax:515-612-9618
Practice Address - Street 1:1200 VALLEY WEST DR STE 304-11
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1903
Practice Address - Country:US
Practice Address - Phone:515-310-1069
Practice Address - Fax:515-612-9618
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker