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General NPI Number Information
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NPI Number | 1356377782
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Entity Type | Individual
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Provider Name | JACKLYN DEAS M.S.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7305 N MILITARY TRL ASPS 126
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City | RIVIERA BEACH
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State | FL
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Zip | 33410-7417
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Country | US
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Telephone | 561-422-6234
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Fax |
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Provider Business Mailing Address
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Address Line | 14769 60TH ST N
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-4565
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY730
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License Number State | FL
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