Provider Demographics
NPI:1265193163
Name:PARZYCH, JACQUELYNN (LICSW)
Entity type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:
Last Name:PARZYCH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SILVERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9151
Mailing Address - Country:US
Mailing Address - Phone:651-324-3572
Mailing Address - Fax:
Practice Address - Street 1:1224 SILVERWOOD CT
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9151
Practice Address - Country:US
Practice Address - Phone:651-324-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN156061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical