Provider Demographics
NPI:1013536614
Name:BATTLE, JACQUELYN PATRICE (LMSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:PATRICE
Last Name:BATTLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:JACQUELYN
Other - Middle Name:PATRICE
Other - Last Name:BATTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2262 E HAZELTINE WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4641
Mailing Address - Country:US
Mailing Address - Phone:919-702-3006
Mailing Address - Fax:
Practice Address - Street 1:1411 N PASADENA
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-2706
Practice Address - Country:US
Practice Address - Phone:919-702-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty