Provider Demographics
NPI:1649765751
Name:KLEINSCHRODT, JACLYN
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:KLEINSCHRODT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BYBERRY RD STE 1203
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3524
Mailing Address - Country:US
Mailing Address - Phone:215-517-1100
Mailing Address - Fax:215-517-1129
Practice Address - Street 1:1800 BYBERRY RD STE 1203
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3524
Practice Address - Country:US
Practice Address - Phone:215-517-1100
Practice Address - Fax:215-517-1129
Is Sole Proprietor?:No
Enumeration Date:2018-06-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363A00000X
PAMA063477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant