Provider Demographics
NPI:1619638657
Name:WALDMAN, JACKELYN R (SPECIAL EDUCATOR)
Entity Type:Individual
Prefix:MRS
First Name:JACKELYN
Middle Name:R
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:MISS
Other - First Name:JACKELYN
Other - Middle Name:R
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPECIAL EDUCATOR
Mailing Address - Street 1:2019 NANCY BLVD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3119
Mailing Address - Country:US
Mailing Address - Phone:516-359-2380
Mailing Address - Fax:
Practice Address - Street 1:FAMILY OF KIDZ
Practice Address - Street 2:1400 OLD COUNTRY ROAD
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-806-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist