Provider Demographics
NPI:1285888909
Name:RAESE, JANE ANNETTE (MSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANNETTE
Last Name:RAESE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E OVERTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5946
Mailing Address - Country:US
Mailing Address - Phone:214-266-4264
Mailing Address - Fax:
Practice Address - Street 1:303 E OVERTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5946
Practice Address - Country:US
Practice Address - Phone:214-266-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical