Healthcare Provider Details

I. General information

NPI: 1811436165
Provider Name (Legal Business Name): JACLYN M GLEASON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN M ZEMBRODT LPCC

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOME RD
COVINGTON KY
41011-1942
US

IV. Provider business mailing address

200 HOME RD
COVINGTON KY
41011-1942
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-8768
  • Fax: 859-291-2431
Mailing address:
  • Phone: 859-261-8768
  • Fax: 859-291-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number171643
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: