Provider Demographics
NPI:1952617656
Name:BELLABY, JACLYN W (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:W
Last Name:BELLABY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:J
Other - Last Name:WILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 PARK AVE
Mailing Address - Street 2:JEWISH HOME FOR THE ELDERLY
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1049
Mailing Address - Country:US
Mailing Address - Phone:203-365-6400
Mailing Address - Fax:
Practice Address - Street 1:4200 PARK AVE
Practice Address - Street 2:JEWISH HOME FOR THE ELDERLY
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1049
Practice Address - Country:US
Practice Address - Phone:203-365-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4160235Z00000X
NY021031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist