Basic Information
| Provider Information | |||||||||
| NPI: | 1104105469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMALO | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 331 PARADISE POINT WAY | ||||||||
| Address2: | |||||||||
| City: | FORKED RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087314302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175170764 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 LAKEHURST RD | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087558064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329148022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2011 | ||||||||
| LastUpdateDate: | 12/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 41YA00079800 | NJ | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.