Provider Demographics
NPI:1043617228
Name:POLARA, JACQUILYN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACQUILYN
Middle Name:
Last Name:POLARA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6825
Mailing Address - Country:US
Mailing Address - Phone:516-668-2326
Mailing Address - Fax:
Practice Address - Street 1:426 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6825
Practice Address - Country:US
Practice Address - Phone:516-668-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist