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General NPI Number Information
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NPI Number | 1023463072
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Entity Type | Individual
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Provider Name | JACLYNN MALVAROSA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 145 NASHVILLE COMMONS DR
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City | NASHVILLE
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State | NC
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Zip | 27856-1823
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Country | US
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Telephone | 845-416-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 6678 ANNABELLA RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27803-8141
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Country | US
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Telephone | 845-416-0599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12756
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License Number State | NC
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