MEDICARE: JACLYN SUE SLESAREVA MSSW, LCSW, CSAC

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	9156-123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336616523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN SUE SLESAREVA MSSW, LCSW, CSAC

Provider Business Mailing Address
First Line	:	524 W VERONA AVE STE 105
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-1443
Country	:	US
Telephone Number	:	608-845-2081
Fax Number	:	608-845-2065

Provider Business Practice Location Address
First Line	:	524 W VERONA AVE STE 105
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-1443
Country	:	US
Telephone Number	:	608-845-2081
Fax Number	:	608-845-2065

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

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	07/15/2021

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