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General NPI Number Information
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NPI Number | 1619296886
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Entity Type | Individual
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Provider Name | JACLYN YEVONNE DORSEY M.ED., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 334 GRAVES RD
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City | ACWORTH
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State | GA
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Zip | 30101-6172
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Country | US
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Telephone | 404-510-8892
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Fax | 404-382-2369
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Provider Business Mailing Address
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Address Line | 78 OPAL ST
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2848
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Country | US
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Telephone | 404-382-6120
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Fax | 404-382-2382
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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 | SLP007224
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License Number State | GA
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