Provider Demographics
NPI:1760785224
Name:ZASKE, JACQUELINE K (LICSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:ZASKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:K
Other - Last Name:REBSTOCK-SERBUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:1125 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4675
Mailing Address - Country:US
Mailing Address - Phone:320-235-4613
Mailing Address - Fax:
Practice Address - Street 1:1125 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4675
Practice Address - Country:US
Practice Address - Phone:320-235-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302974101YA0400X
MN290751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)