Provider Demographics
NPI:1871740886
Name:MINDLER, JACQUELINE A (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:MINDLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 AMWELL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1225
Mailing Address - Country:US
Mailing Address - Phone:732-729-0069
Mailing Address - Fax:732-873-7676
Practice Address - Street 1:390 AMWELL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1225
Practice Address - Country:US
Practice Address - Phone:732-729-0069
Practice Address - Fax:732-873-7676
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00295600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist