Provider Demographics
NPI:1760911945
Name:NASBY, JACQUELYN E (PROF COUNS IN TRAINI)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:E
Last Name:NASBY
Suffix:
Gender:F
Credentials:PROF COUNS IN TRAINI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3849
Mailing Address - Country:US
Mailing Address - Phone:414-817-8896
Mailing Address - Fax:414-817-8940
Practice Address - Street 1:7330 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220
Practice Address - Country:US
Practice Address - Phone:414-817-8896
Practice Address - Fax:414-817-8940
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2926-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health