Provider Demographics
NPI:1548983471
Name:MARTINEAU, JACLYN MAE (LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MAE
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACKI
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2013 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-5003
Mailing Address - Country:US
Mailing Address - Phone:952-270-5872
Mailing Address - Fax:
Practice Address - Street 1:3220 4TH ST E STE 102
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3082
Practice Address - Country:US
Practice Address - Phone:701-501-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND53711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical