Provider Demographics
NPI:1427250398
Name:HAUGHEY, JACOLYN BETH (MSOTR,L)
Entity type:Individual
Prefix:
First Name:JACOLYN
Middle Name:BETH
Last Name:HAUGHEY
Suffix:
Gender:F
Credentials:MSOTR,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22317 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2153
Mailing Address - Country:US
Mailing Address - Phone:302-856-7364
Mailing Address - Fax:302-856-7296
Practice Address - Street 1:22317 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2153
Practice Address - Country:US
Practice Address - Phone:302-856-7364
Practice Address - Fax:302-856-7296
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0000791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist