Provider Demographics
NPI:1285418038
Name:KROTZ, JACKLYN
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:KROTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:
Other - Last Name:KAVESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 HATBORO RD
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1119
Mailing Address - Country:US
Mailing Address - Phone:609-774-6998
Mailing Address - Fax:
Practice Address - Street 1:235 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1560
Practice Address - Country:US
Practice Address - Phone:484-551-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional