Provider Demographics
NPI:1700296167
Name:STAGG, JACQUELINE (LHIS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:STAGG
Suffix:
Gender:F
Credentials:LHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 N MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1350
Mailing Address - Country:US
Mailing Address - Phone:508-674-3334
Mailing Address - Fax:508-674-5855
Practice Address - Street 1:1822 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1350
Practice Address - Country:US
Practice Address - Phone:508-674-3334
Practice Address - Fax:508-674-5855
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142355A2700X
MA295237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant