Provider Demographics
NPI:1699035261
Name:VALENTINE, JACLYN ANN (CCC-SLP TSSLD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PHEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2512
Mailing Address - Country:US
Mailing Address - Phone:914-497-1765
Mailing Address - Fax:
Practice Address - Street 1:16 FOXWOOD DR APT 6
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-1635
Practice Address - Country:US
Practice Address - Phone:914-497-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist