Provider Demographics
NPI:1962988436
Name:BARON, JACQUELINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BARON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 DAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2304
Mailing Address - Country:US
Mailing Address - Phone:914-582-4310
Mailing Address - Fax:
Practice Address - Street 1:35 DAY AVE
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2304
Practice Address - Country:US
Practice Address - Phone:413-453-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist