Provider Demographics
NPI:1154302701
Name:SPAULDING, JACQUELINE SUSAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SUSAN
Last Name:SPAULDING
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 1:4013 OLD OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3132
Mailing Address - Country:US
Mailing Address - Phone:502-741-3980
Mailing Address - Fax:502-966-5114
Practice Address - Street 1:4013 OLD OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3132
Practice Address - Country:US
Practice Address - Phone:502-741-3980
Practice Address - Fax:502-966-5114
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical