Provider Demographics
NPI:1003055708
Name:DOLSON-SHEWCHUK, JACQUELINE CHRISTINE (MSLP CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:DOLSON-SHEWCHUK
Suffix:
Gender:F
Credentials:MSLP CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:78 W 85TH ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4568
Mailing Address - Country:US
Mailing Address - Phone:212-595-5352
Mailing Address - Fax:212-580-1910
Practice Address - Street 1:241 W 72ND ST # 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2703
Practice Address - Country:US
Practice Address - Phone:212-580-1910
Practice Address - Fax:212-580-1910
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015993-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist