Individual
JACLYN RUTH BOLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
141 SCARBROUGH LN, SHADY SPRING, WV 25918-8590
(304) 578-1983
Mailing address
141 SCARBROUGH LN, SHADY SPRING, WV 25918-8590
(304) 578-1983
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
DP00946319
WV
104100000X
Social Worker
Primary
SW072115940
WV
Other
Enumeration date
08/27/2021
Last updated
07/08/2026
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