Provider Demographics
NPI:1467082313
Name:O'FLAHRITY, JACQUELYN M (APSW MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:M
Last Name:O'FLAHRITY
Suffix:
Gender:F
Credentials:APSW MSW
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:M
Other - Last Name:TAYLOR DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 HUMES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0491
Mailing Address - Country:US
Mailing Address - Phone:608-741-2117
Mailing Address - Fax:608-758-5761
Practice Address - Street 1:2600 HUMES RD STE 100
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0491
Practice Address - Country:US
Practice Address - Phone:608-741-2117
Practice Address - Fax:608-758-5761
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128490-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker