Provider Demographics
NPI:1598231813
Name:FORLANO, JACLENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JACLENE
Middle Name:
Last Name:FORLANO
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 1:23 ROSEN DR
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8429
Mailing Address - Country:US
Mailing Address - Phone:908-670-2590
Mailing Address - Fax:
Practice Address - Street 1:820 TURNPIKE ST STE 104
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6125
Practice Address - Country:US
Practice Address - Phone:978-681-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist