Provider Demographics
NPI:1629806047
Name:CLOUS, JACQUELINE MAE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MAE
Last Name:CLOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 OLD HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8662
Mailing Address - Country:US
Mailing Address - Phone:724-249-1256
Mailing Address - Fax:
Practice Address - Street 1:655 OLD HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8662
Practice Address - Country:US
Practice Address - Phone:724-249-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor