Provider Demographics
NPI:1285513051
Name:GEORGE, JACQUELINN NICKOLE
Entity type:Individual
Prefix:
First Name:JACQUELINN
Middle Name:NICKOLE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINN
Other - Middle Name:NICKOLE
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 S ALDER ST
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1532
Mailing Address - Country:US
Mailing Address - Phone:509-831-0542
Mailing Address - Fax:
Practice Address - Street 1:10 S ALDER ST
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1532
Practice Address - Country:US
Practice Address - Phone:509-831-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker