Provider Demographics
NPI:1033718804
Name:CALLAHAN, JACLYN (LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:915 HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-8113
Mailing Address - Country:US
Mailing Address - Phone:573-333-5875
Mailing Address - Fax:
Practice Address - Street 1:915 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-8113
Practice Address - Country:US
Practice Address - Phone:573-333-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical