MEDICARE: JACLYN WASCO

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1831857572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN WASCO

Provider Business Mailing Address
First Line	:	295 MAHONING AVE
Second Line	:
City	:	NORTH VERSAILLES
State	:	PA
Zip	:	15137-2262
Country	:	US
Telephone Number	:	412-303-6238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 BRODHEAD RD STE 2
Second Line	:
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-2322
Country	:	US
Telephone Number	:	412-339-1982
Fax Number	:

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

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	11/30/2021

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Directions to “ JACLYN WASCO ” Practice Location

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