MEDICARE: JACQUELINE MARY BACLAWSKI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3114-C	AR
2	1041C0700X	Clinical Social Worker	63374	TX

General Provider Information

NPI Number	:	1386950590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MARY BACLAWSKI LCSW

Provider Business Mailing Address
First Line	:	1311 STONE ST
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4523
Country	:	US
Telephone Number	:	870-932-6922
Fax Number	:

Provider Business Practice Location Address
First Line	:	8111 LYNDON B JOHNSON FWY STE 900
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1322
Country	:	US
Telephone Number	:	469-845-9857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	05/20/2026

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