Provider Demographics
NPI:1689471146
Name:MARTIN, JACLYN
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N HERMITAGE AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3233
Mailing Address - Country:US
Mailing Address - Phone:978-758-3883
Mailing Address - Fax:
Practice Address - Street 1:1106 N HERMITAGE AVE APT 1R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3233
Practice Address - Country:US
Practice Address - Phone:978-758-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula