Provider Demographics
NPI:1336462977
Name:WRIGHT, JACQUELINE MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:WRIGHT
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 1:5413 NICOLLET AVE # 164
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1927
Mailing Address - Country:US
Mailing Address - Phone:612-308-2508
Mailing Address - Fax:612-486-9497
Practice Address - Street 1:5413 NICOLLET AVE # 164
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1927
Practice Address - Country:US
Practice Address - Phone:612-308-2508
Practice Address - Fax:612-486-9497
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical