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General NPI Number Information
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NPI Number | 1396118576
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Entity Type | Individual
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Provider Name | JACLYN FLEIG MCD,CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 237 NEWPARK PL
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City | COLUMBIA
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State | SC
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Zip | 29212-8667
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Country | US
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Telephone | 724-766-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 7001 SAINT ANDREWS ROAD SUITE A12 #261
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City | COLUMBIA
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State | SC
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Zip | 29212-1137
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Country | US
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Telephone | 724-766-0556
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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 | 3787
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License Number State | AL
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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 | 6760
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License Number State | SC
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