Provider Demographics
NPI:1801225230
Name:RATHJE, JACLYN JOANN (NCC, LIMHP, CADC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:JOANN
Last Name:RATHJE
Suffix:
Gender:F
Credentials:NCC, LIMHP, CADC
Other - Prefix:MRS
Other - First Name:JACLYN
Other - Middle Name:JOANN
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:917 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-2652
Mailing Address - Country:US
Mailing Address - Phone:402-494-3337
Mailing Address - Fax:
Practice Address - Street 1:917 W 21ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-2652
Practice Address - Country:US
Practice Address - Phone:402-494-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional