Block, Jacquelyn Mae

Block, Jacquelyn Mae is an individual health care provider with primary practice located at 430 E Division St , Fond Du Lac WI 54935-4560. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Marriage & Family Therapist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Block, Jacquelyn Mae can be contacted via phone (920) 926-4209.

Contact Information

Primary practice address
430 E Division St Fond Du Lac WI 54935-4560
Phone: (920) 926-4209
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 226-124 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2841-123 Wisconsin

Profile Details

NPI number 1336360429
LBN Legal business name Block, Jacquelyn Mae
Credentials MFT, LCSW, LMFT
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2007
Last updated Dec 16th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336360429 NPPES
Wisconsin Other 226-124 LMFT
Wisconsin Other 2841-123 LMFT

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