Healthcare Provider Details

I. General information

NPI: 1598399610
Provider Name (Legal Business Name): JACQUELYN ELAINE ZIELEWICZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN ELAINE BAKER LCSW

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1907
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-320-7525
  • Fax: 570-320-7484
Mailing address:
  • Phone:
  • Fax: 570-326-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020497
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: