Healthcare Provider Details

I. General information

NPI: 1851496251
Provider Name (Legal Business Name): MRS. JACQULYN SUE SLOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JACQULYN SUE KEENAN

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HOWARD ST
BRIDGEPORT OH
43912-1126
US

IV. Provider business mailing address

69713 CRESTVIEW LN
SAINT CLAIRSVILLE OH
43950-8313
US

V. Phone/Fax

Practice location:
  • Phone: 740-635-1535
  • Fax:
Mailing address:
  • Phone: 740-695-9479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2068
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number690
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: