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General NPI Number Information
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NPI Number | 1336616523
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Entity Type | Individual
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Provider Name | JACLYN SUE SLESAREVA MSSW, LCSW, CSAC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 524 W VERONA AVE STE 105
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City | VERONA
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State | WI
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Zip | 53593-1443
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Country | US
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Telephone | 608-845-2081
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Fax | 608-845-2065
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Provider Business Mailing Address
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Address Line | 524 W VERONA AVE STE 105
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City | VERONA
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State | WI
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Zip | 53593-1443
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Country | US
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Telephone | 608-845-2081
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Fax | 608-845-2065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9156-123
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License Number State | WI
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