Jackie Boling, LCSW
Individual provider Active NPI Clinical Social Worker · Bossier City, LA
NPI 1386181790 · NPPES record last updated Aug 9, 2022
Key facts
- NPI
- 1386181790
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 16719 (LA)
- Practice address
- 401 Jordan Dr
Bossier City, LA 71112-4079 - Phone
- (707) 548-9996
- NPI assigned
- Jan 23, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16719 | LA | MD | Clinical Social Worker |
| 104821 | TX | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW.09926683 | CO | |
| Clinical Social Worker | 1041C0700X | 104821 | TX | |
| Clinical Social Worker | 1041C0700X | 16719 | LA | Yes |
Addresses
Primary practice location
401 Jordan Dr
Bossier City, LA 71112-4079
Mailing address
401 Jordan Dr
Bossier City, LA 71112-4079
Other providers in Bossier City, LA
- Alice C Blue
- Jenita Blue
- Abigail Davis Bogan
- Peter Bryan Boggs
- Shamarie Bolden
- William A. Bolinger
- Katherine D Bolls
- Jennifer Jenkins Bonar
- April Bonner
- Blaine Alan Bonnett
All providers in Bossier City, LA · Clinical Social Worker in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.