Provider Demographics
NPI:1659837847
Name:TOHAL, JACQUELIN ANN (LICSW)
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:ANN
Last Name:TOHAL
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 1:3 CIVIC CENTER PLZ STE 300
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7790
Mailing Address - Country:US
Mailing Address - Phone:507-901-1033
Mailing Address - Fax:507-901-1034
Practice Address - Street 1:3 CIVIC CENTER PLZ STE 300
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7790
Practice Address - Country:US
Practice Address - Phone:507-901-1033
Practice Address - Fax:507-901-1034
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25880101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health