Individual
JACQUELYN DEECARLO-OMORUYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
525 PORTLAND AVE # MC963, MINNEAPOLIS, MN 55415-1533
(218) 969-0948
(612) 677-6248
Mailing address
525 PORTLAND AVE # MC963, MINNEAPOLIS, MN 55415-1533
(218) 969-0948
(612) 677-6248
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
27320
MN
Other
Enumeration date
10/22/2020
Last updated
02/12/2021
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