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General NPI Number Information
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NPI Number | 1336764786
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Entity Type | Individual
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Provider Name | JACLYN FAVALE
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Gender | Female
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 601 CATOCTIN CIR NE
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City | LEESBURG
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State | VA
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Zip | 20176-4964
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Country | US
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Telephone | 347-556-3920
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Fax |
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Provider Business Mailing Address
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Address Line | 60 CHATWELL TER
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City | CHARLES TOWN
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State | WV
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Zip | 25414-1212
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Country | US
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Telephone |
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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 |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202010106
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License Number State | VA
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