Provider Demographics
NPI:1437290376
Name:HART, JACQUELINE KAY (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:KAY
Last Name:HART
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 1:807 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1077
Mailing Address - Country:US
Mailing Address - Phone:507-634-3512
Mailing Address - Fax:
Practice Address - Street 1:2746 SUPERIOR DR NW
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8343
Practice Address - Country:US
Practice Address - Phone:507-288-0064
Practice Address - Fax:507-288-3993
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist