Provider Demographics
NPI:1124265350
Name:KURLAND, JACQUIE (PHD, CCC-SLP)
Entity type:Individual
Prefix:PROF
First Name:JACQUIE
Middle Name:
Last Name:KURLAND
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 N PLEASANT ST
Mailing Address - Street 2:ROOM 307A
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9296
Mailing Address - Country:US
Mailing Address - Phone:413-545-4007
Mailing Address - Fax:413-545-0803
Practice Address - Street 1:358 N PLEASANT ST
Practice Address - Street 2:ROOM 307A
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9296
Practice Address - Country:US
Practice Address - Phone:413-545-4007
Practice Address - Fax:413-545-0803
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP7338SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist