Provider Demographics
NPI:1902174717
Name:ADOLPH, JACQUELINE (CPO, LPO)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:ADOLPH
Suffix:
Gender:F
Credentials:CPO, LPO
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6011 HARRY HINES BLVD V5 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9091
Mailing Address - Country:US
Mailing Address - Phone:214-645-8254
Mailing Address - Fax:214-645-8258
Practice Address - Street 1:6011 HARRY HINES BLVD V5 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9091
Practice Address - Country:US
Practice Address - Phone:214-645-8254
Practice Address - Fax:214-645-8258
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1577222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist