Healthcare Provider Details

I. General information

NPI: 1477522720
Provider Name (Legal Business Name): JACQUELINE MARIE KLEIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JACQUELINE MARIE LA PUMA

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4526
  • Fax: 518-262-6896
Mailing address:
  • Phone: 518-262-4526
  • Fax: 518-262-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number012474-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: