Individual provider Active NPI

Susan Colleen Stephens-Dagley, LCSW

  • Clinical Social Worker
  • Joplin, MO
National Provider Identifier
1114626728
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2004024490 Issued in MO
Practice address
135 Valleyview Dr
Joplin, MO 64804-5236
Phone
(417) 434-5705
NPI assigned
Mar 2, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2004024490 MO Primary

Addresses

Primary practice location

135 Valleyview Dr
Joplin, MO 64804-5236

Mailing address

PO Box 4721
Joplin, MO 64803-4721
Phone (417) 434-5705

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2004024490MOMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1114626728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4721",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648034721",
            "telephone_number": "417-434-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 VALLEYVIEW DR",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648045236",
            "telephone_number": "417-434-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS-DAGLEY",
        "first_name": "SUSAN",
        "middle_name": "COLLEEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-02",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2004024490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.