Provider Demographics
NPI:1851881577
Name:AUSTIN, JACQUELINE A (MSSA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSA
Mailing Address - Street 1:14 HAIG POINT CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6474
Mailing Address - Country:US
Mailing Address - Phone:330-294-8114
Mailing Address - Fax:
Practice Address - Street 1:14 HAIG POINT CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6474
Practice Address - Country:US
Practice Address - Phone:330-294-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6442-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker