Provider Demographics
NPI:1770593170
Name:STRATTON, JACQUELINE MARY (MSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARY
Last Name:STRATTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8646 EAGLE CREEK CIR STE 213
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1574
Mailing Address - Country:US
Mailing Address - Phone:952-583-1055
Mailing Address - Fax:612-437-4463
Practice Address - Street 1:8646 EAGLE CREEK CIR STE 213
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1574
Practice Address - Country:US
Practice Address - Phone:952-583-1055
Practice Address - Fax:612-437-4463
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN043701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN576717200Medicaid