Provider Demographics
NPI:1336560192
Name:LACINSKI, JAQUELINE S
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:S
Last Name:LACINSKI
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 1:334 INDIAN ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1925
Mailing Address - Country:US
Mailing Address - Phone:484-326-9900
Mailing Address - Fax:610-544-7142
Practice Address - Street 1:475 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3747
Practice Address - Country:US
Practice Address - Phone:484-450-6476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist