Provider Demographics
NPI:1730897364
Name:RIGGINS, JENIFER MARIE (LCSW, MPA, PMH-C)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:MARIE
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:LCSW, MPA, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 E BROADWAY RD STE 101470
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-1579
Mailing Address - Country:US
Mailing Address - Phone:602-580-5816
Mailing Address - Fax:
Practice Address - Street 1:15455 N GREENWAY HAYDEN LOOP STE C9
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1887
Practice Address - Country:US
Practice Address - Phone:602-580-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-205321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty