Provider Demographics
NPI:1750827911
Name:STROEHL, JACLYN (LSW)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:STROEHL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 WESTRAC DR S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2338
Mailing Address - Country:US
Mailing Address - Phone:701-551-6348
Mailing Address - Fax:
Practice Address - Street 1:1202 WESTRAC DR S
Practice Address - Street 2:SUITE 100
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2338
Practice Address - Country:US
Practice Address - Phone:701-551-6348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5367104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker