MEDICARE: JAYCIE PONCE

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	SLP014065	GA

General Provider Information

NPI Number	:	1336084722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYCIE PONCE

Provider Business Mailing Address
First Line	:	1854 AUBURN RD STE 101
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-1130
Country	:	US
Telephone Number	:	770-904-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SHERWOOD PARK DR NE STE 220
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3426
Country	:	US
Telephone Number	:	678-971-5048
Fax Number	:	770-904-2357

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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Directions to “ JAYCIE PONCE ” Practice Location

Language	Start Address	Practice Location

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