Provider Demographics
NPI:1831489392
Name:INGROUILLE, JACQUELINE ANN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANN
Last Name:INGROUILLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:BLOMSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:714 W. COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4906
Mailing Address - Country:US
Mailing Address - Phone:218-724-8815
Mailing Address - Fax:218-724-0251
Practice Address - Street 1:714 W. COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4906
Practice Address - Country:US
Practice Address - Phone:218-724-8815
Practice Address - Fax:218-724-0251
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN190061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical