Provider Demographics
NPI:1679870620
Name:SHIFLET, JACQUELINE HALL (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HALL
Last Name:SHIFLET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MAIDSTONE CV
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3330
Mailing Address - Country:US
Mailing Address - Phone:210-722-3209
Mailing Address - Fax:
Practice Address - Street 1:218 MAIDSTONE CV
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3330
Practice Address - Country:US
Practice Address - Phone:210-722-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 64821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical