Provider Demographics
NPI:1578876223
Name:SCHULTZ, JACQUELYN KAY (LISW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:KAY
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:MASONVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50654-8516
Mailing Address - Country:US
Mailing Address - Phone:319-361-4867
Mailing Address - Fax:563-927-3939
Practice Address - Street 1:805 CHARLES ST
Practice Address - Street 2:
Practice Address - City:MASONVILLE
Practice Address - State:IA
Practice Address - Zip Code:50654-8516
Practice Address - Country:US
Practice Address - Phone:319-361-4867
Practice Address - Fax:563-927-3939
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA045431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA600931888Medicaid