Provider Demographics
NPI:1013685601
Name:QUINLAN, JACLYN (MPH RD LDN)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:MPH RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DANFORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1701
Mailing Address - Country:US
Mailing Address - Phone:781-572-0952
Mailing Address - Fax:
Practice Address - Street 1:52 SECOND AVE STE 340
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1133
Practice Address - Country:US
Practice Address - Phone:781-466-8967
Practice Address - Fax:781-466-8987
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4838133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered