Provider Demographics
NPI:1275931693
Name:KLEIN, JACQUELINE B
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:B
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 MAIN STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504
Mailing Address - Country:US
Mailing Address - Phone:914-273-6820
Mailing Address - Fax:914-273-6840
Practice Address - Street 1:355 MAIN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504
Practice Address - Country:US
Practice Address - Phone:914-273-6820
Practice Address - Fax:914-273-6840
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007446-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist