Provider Demographics
NPI:1881981496
Name:DERBY, JACQUELINE DOROTHY (MS, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DOROTHY
Last Name:DERBY
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E EVANS BLVD
Mailing Address - Street 2:APT B
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-3258
Mailing Address - Country:US
Mailing Address - Phone:603-944-7012
Mailing Address - Fax:
Practice Address - Street 1:1000 E EVANS BLVD
Practice Address - Street 2:APT B
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-3258
Practice Address - Country:US
Practice Address - Phone:603-944-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-1968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist