Provider Demographics
NPI:1609242197
Name:WHITMAN, JACLYN (MS ED SPECIAL ED)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:MS ED SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 LAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9535
Mailing Address - Country:US
Mailing Address - Phone:518-456-3268
Mailing Address - Fax:518-464-1469
Practice Address - Street 1:230 WASHINGTON AVE EXTENTION
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-456-3268
Practice Address - Fax:518-464-1469
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1268386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist