Provider Demographics
NPI:1780223149
Name:ARDEN, JACLYNN (LMT)
Entity Type:Individual
Prefix:
First Name:JACLYNN
Middle Name:
Last Name:ARDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 ALGODONES CT SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2801
Mailing Address - Country:US
Mailing Address - Phone:719-722-6174
Mailing Address - Fax:
Practice Address - Street 1:4011 BARBARA LOOP SE STE 104A
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1040
Practice Address - Country:US
Practice Address - Phone:719-722-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist