MEDICARE: JACQUELINE MOEN KADLEC

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	133002-121	WI

General Provider Information

NPI Number	:	1871299065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MOEN KADLEC

Provider Business Mailing Address
First Line	:	531 SUNSET PL
Second Line	:
City	:	TAYLOR
State	:	WI
Zip	:	54659-9515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 SUNSET PL
Second Line	:
City	:	TAYLOR
State	:	WI
Zip	:	54659-9515
Country	:	US
Telephone Number	:	715-662-3014
Fax Number	:

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

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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