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NPI Code Detail

MEDICARE: JACLYN HAYLEY HARRISON

MEDICARE: JACLYN HAYLEY HARRISON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1306565379
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN HAYLEY HARRISON
Provider Business Mailing Address
First Line : 154 BAY RIDGE PKWY APT 3
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-2352
Country : US
Telephone Number : 347-831-4243
Fax Number :
Provider Business Practice Location Address
First Line : 154 BAY RIDGE PKWY APT 3
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-2352
Country : US
Telephone Number : 347-831-4243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2022
Last Update Date : 08/24/2022

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Directions to “ JACLYN HAYLEY HARRISON ” Practice Location

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