Provider Demographics
NPI:1811083439
Name:SLOBOF, JENELLE (LICSW/LCSW-BACS)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:SLOBOF
Suffix:
Gender:F
Credentials:LICSW/LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 JAMES CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3640
Mailing Address - Country:US
Mailing Address - Phone:561-308-5904
Mailing Address - Fax:
Practice Address - Street 1:1016 JAMES CT
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3640
Practice Address - Country:US
Practice Address - Phone:561-308-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11655104100000X
FLSW71551041C0700X
LA119281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN975724400Medicaid
MN152298OtherBEHAVIORAL HEALTHCARE
MN800001899Medicare Oscar/Certification
MN800001895Medicare Oscar/Certification