Provider Demographics
NPI:1023178399
Name:VOLKMANN, JACQUELINE A (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:VOLKMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 TECHNOLOGY WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2009
Mailing Address - Country:US
Mailing Address - Phone:775-687-7573
Mailing Address - Fax:775-687-7544
Practice Address - Street 1:1825 PINION RD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8318
Practice Address - Country:US
Practice Address - Phone:775-738-8021
Practice Address - Fax:775-738-8842
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4514-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100714Medicare PIN