Provider Demographics
NPI:1053803569
Name:SCOGGINS, JENNIFER (LCSW, LADAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KEELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3721 LAURAL RDG
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-1086
Mailing Address - Country:US
Mailing Address - Phone:479-616-3593
Mailing Address - Fax:
Practice Address - Street 1:417 MAPLE ST.
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764
Practice Address - Country:US
Practice Address - Phone:479-616-3593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8940-C1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health