Provider Demographics
NPI:1114200219
Name:HANZL, JACQUELINE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:HANZL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JACQUELIN
Other - Middle Name:
Other - Last Name:FELCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:BOICEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12412-0300
Mailing Address - Country:US
Mailing Address - Phone:845-657-6383
Mailing Address - Fax:
Practice Address - Street 1:8 W HURLEY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1822
Practice Address - Country:US
Practice Address - Phone:845-657-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist