Provider Demographics
NPI:1376883165
Name:RENDFREY, JACKLYN SARAH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:SARAH
Last Name:RENDFREY
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 1:12 WINDINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2902
Mailing Address - Country:US
Mailing Address - Phone:856-767-2903
Mailing Address - Fax:
Practice Address - Street 1:12 WINDINGBROOK DR
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2902
Practice Address - Country:US
Practice Address - Phone:856-767-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00717400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist