Provider Demographics
NPI:1598004269
Name:ACH, JAQUELYN (SPED)
Entity Type:Individual
Prefix:MRS
First Name:JAQUELYN
Middle Name:
Last Name:ACH
Suffix:
Gender:F
Credentials:SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WILLETS DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3915
Mailing Address - Country:US
Mailing Address - Phone:516-802-2096
Mailing Address - Fax:
Practice Address - Street 1:79 WILLETS DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3915
Practice Address - Country:US
Practice Address - Phone:516-802-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY524395251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services