MEDICARE: JACLYN DIANA LORRAINE M.A., CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	146017873	IL

General Provider Information

NPI Number	:	1376097816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN DIANA LORRAINE M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1817 W MORSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3108
Country	:	US
Telephone Number	:	724-650-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525C LEBANON PIKE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-2473
Country	:	US
Telephone Number	:	615-669-0761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2016
Last Update Date	:	01/31/2026

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Directions to “ JACLYN DIANA LORRAINE M.A., CCC-SLP” Practice Location

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