Provider Demographics
NPI:1316650930
Name:SZALACINSKI, JACQUELYN (BSN, RN, IBCLC, CLC)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:SZALACINSKI
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 ORCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-6503
Mailing Address - Country:US
Mailing Address - Phone:414-630-5398
Mailing Address - Fax:
Practice Address - Street 1:W307N1497 GOLF RD STE 102
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2112
Practice Address - Country:US
Practice Address - Phone:262-204-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI222576163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant