Provider Demographics
NPI:1558848994
Name:PIELAK, JENNIFER SUE (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:PIELAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4824
Mailing Address - Country:US
Mailing Address - Phone:309-283-1304
Mailing Address - Fax:
Practice Address - Street 1:2326 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4824
Practice Address - Country:US
Practice Address - Phone:309-283-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker