Provider Demographics
NPI:1740983055
Name:TROUTNER, JACQLYN T
Entity type:Individual
Prefix:
First Name:JACQLYN
Middle Name:T
Last Name:TROUTNER
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 1:1608 LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-1624
Mailing Address - Country:US
Mailing Address - Phone:609-287-7020
Mailing Address - Fax:
Practice Address - Street 1:1608 LONDON AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-1624
Practice Address - Country:US
Practice Address - Phone:609-287-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician