Provider Demographics
NPI:1841748589
Name:STRATTON, JACQUELYN (LAC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:STRATTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:FICHTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-5221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 MINUTE MAN TRL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4916
Practice Address - Country:US
Practice Address - Phone:585-750-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25005805171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist