Provider Demographics
NPI:1861939548
Name:JAMES, JACKLYN
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7143 ELGIN DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-2426
Mailing Address - Country:US
Mailing Address - Phone:302-381-0058
Mailing Address - Fax:
Practice Address - Street 1:12337 CONCORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-8273
Practice Address - Country:US
Practice Address - Phone:302-381-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DERBT-20-143138106S00000X
AZSLPA10432235Z00000X
DE1-23-65006103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist