Provider Demographics
NPI:1922063965
Name:DARNELL, JEFFREY ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:DARNELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:24691 EMBAY AVE
Mailing Address - Street 2:APT B
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-4345
Mailing Address - Country:US
Mailing Address - Phone:800-872-8662
Mailing Address - Fax:608-372-1779
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:425/7
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:800-872-8662
Practice Address - Fax:608-372-1779
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO989488104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker