Organization
AUTISM REC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE LACINSKI MA, CCC-SLP (SPEECH THERAPIST)
(484) 326-9900
Entity
Organization
Contact information
Practice address
1140 S 26TH ST, PHILADELPHIA, PA 19146-3849
(215) 200-0405
Mailing address
PO BOX 605, DARBY, PA 19023-0605
(215) 200-0405
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336560192
—
PA
Enumeration date
04/14/2022
Last updated
04/14/2022
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