Provider Demographics
NPI:1134465800
Name:INGLIS, JACQUELINE ELYSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ELYSE
Last Name:INGLIS
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 1:165 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1303
Mailing Address - Country:US
Mailing Address - Phone:650-868-9664
Mailing Address - Fax:
Practice Address - Street 1:165 ARCH ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1303
Practice Address - Country:US
Practice Address - Phone:650-363-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS160211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical