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General NPI Number Information
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NPI Number | 1184438814
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Entity Type | Individual
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Provider Name | JACLYN KEANE
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 43 LINCOLN AVE
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City | COLONIA
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State | NJ
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Zip | 07067-4040
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Country | US
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Telephone | 732-770-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 149 IRON ORE RD
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City | MANALAPAN
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State | NJ
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Zip | 07726-8030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14449999
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License Number State | NJ
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