Provider Demographics
NPI:1861691834
Name:STAYER, JODY ANN (MA)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:ANN
Last Name:STAYER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:JODY
Other - Middle Name:ANN
Other - Last Name:REDIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 E KATELLA AVE
Mailing Address - Street 2:UNIT 3150
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6680
Mailing Address - Country:US
Mailing Address - Phone:714-613-3288
Mailing Address - Fax:
Practice Address - Street 1:4401 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1611
Practice Address - Country:US
Practice Address - Phone:626-798-6793
Practice Address - Fax:626-797-7722
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAIMF 55885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator