Healthcare Provider Details

I. General information

NPI: 1740104496
Provider Name (Legal Business Name): JOCELYN LAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 N CLINTON ST
FORT WAYNE IN
46805-1918
US

IV. Provider business mailing address

2827 WESTBROOK DR APT 526
FORT WAYNE IN
46805-2062
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-2100
  • Fax:
Mailing address:
  • Phone: 260-431-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22009604A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: