Provider Demographics
NPI:1497928576
Name:RICE, JACQUELYN ARTENIA (MSSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:ARTENIA
Last Name:RICE
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:MS
Other - First Name:JACQUELYN
Other - Middle Name:ARTENIA
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW LCSW
Mailing Address - Street 1:2676 N GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2440
Mailing Address - Country:US
Mailing Address - Phone:414-442-6258
Mailing Address - Fax:
Practice Address - Street 1:2676 N GRANT BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2440
Practice Address - Country:US
Practice Address - Phone:414-442-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3837 1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical