MEDICARE: MS. JACLYN BECKY ROSENBLUM SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1093363152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACLYN BECKY ROSENBLUM SLP

Provider Business Mailing Address
First Line	:	285 CENTRAL AVE APT B5
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1575
Country	:	US
Telephone Number	:	516-232-6938
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 E 98TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-3801
Country	:	US
Telephone Number	:	347-289-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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