Provider Demographics
NPI:1992757207
Name:DI JACKLIN, MARGARET M (LCSW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:DI JACKLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17625 EL CAMINO REAL
Mailing Address - Street 2:160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3052
Mailing Address - Country:US
Mailing Address - Phone:281-798-9362
Mailing Address - Fax:281-286-0041
Practice Address - Street 1:17625 EL CAMINO REAL
Practice Address - Street 2:160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3052
Practice Address - Country:US
Practice Address - Phone:281-798-9362
Practice Address - Fax:281-286-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S64NMedicare ID - Type Unspecified