Provider Demographics
NPI:1134808264
Name:ARNOLD, JALEN JENEVEVE (LICSW)
Entity type:Individual
Prefix:
First Name:JALEN
Middle Name:JENEVEVE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5986 OAKWOOD TER NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-9705
Mailing Address - Country:US
Mailing Address - Phone:507-473-3011
Mailing Address - Fax:
Practice Address - Street 1:5986 OAKWOOD TER NW
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-9705
Practice Address - Country:US
Practice Address - Phone:507-473-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical