Provider Demographics
NPI:1386950590
Name:BACLAWSKI, JACQUELINE MARY (LMSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARY
Last Name:BACLAWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4523
Mailing Address - Country:US
Mailing Address - Phone:870-932-6922
Mailing Address - Fax:
Practice Address - Street 1:8111 LYNDON B JOHNSON FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1322
Practice Address - Country:US
Practice Address - Phone:469-845-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker