Provider Demographics
NPI:1598306854
Name:CONNELL, JACQUELINE (APSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7358 NEW WASHBURN WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3010
Mailing Address - Country:US
Mailing Address - Phone:608-334-8410
Mailing Address - Fax:
Practice Address - Street 1:996 STORYTOWN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:WI
Practice Address - Zip Code:53521-9456
Practice Address - Country:US
Practice Address - Phone:608-334-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131185-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker