Provider Demographics
NPI:1003871740
Name:VON DER LINDEN, JAYNE E (MSW)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:E
Last Name:VON DER LINDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:E
Other - Last Name:SKOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 CROOKS ST
Mailing Address - Street 2:PO BOX 22308
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4527
Mailing Address - Country:US
Mailing Address - Phone:920-436-6800
Mailing Address - Fax:920-432-5966
Practice Address - Street 1:300 CROOKS ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4527
Practice Address - Country:US
Practice Address - Phone:920-436-6800
Practice Address - Fax:920-432-5966
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42891231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43559200Medicaid
P00214690OtherMEDICARE RAILROAD
WI852060014Medicare ID - Type Unspecified
P00214690OtherMEDICARE RAILROAD