Provider Demographics
NPI:1619224094
Name:ROSENBLATT, JACLYN (MS)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ROSENBLATT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2318
Mailing Address - Country:US
Mailing Address - Phone:305-282-5658
Mailing Address - Fax:
Practice Address - Street 1:731 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2318
Practice Address - Country:US
Practice Address - Phone:305-282-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605337121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist