Provider Demographics
NPI:1689224354
Name:STOEBE, JACQUELYN (MA, TSSLD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:STOEBE
Suffix:
Gender:F
Credentials:MA, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MANOR OAK DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3442
Mailing Address - Country:US
Mailing Address - Phone:716-245-0817
Mailing Address - Fax:
Practice Address - Street 1:9812 LOCKPORT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1114
Practice Address - Country:US
Practice Address - Phone:716-297-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist