Provider Demographics
NPI:1093363152
Name:ROSENBLUM, JACLYN BECKY (SLP)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:BECKY
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 CENTRAL AVE APT B5
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1575
Mailing Address - Country:US
Mailing Address - Phone:516-232-6938
Mailing Address - Fax:
Practice Address - Street 1:123 E 98TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3801
Practice Address - Country:US
Practice Address - Phone:347-289-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist