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NPI Code Detail

MEDICARE: JACLYN UNTRECHT SLP

MEDICARE: JACLYN UNTRECHT 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
1235Z00000XSpeech-Language PathologistSLP14577AZ

General Provider Information

NPI Number : 1720897721
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN UNTRECHT SLP
Provider Business Mailing Address
First Line : 4635 N 14TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4016
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4635 N 14TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4016
Country : US
Telephone Number : 602-264-9039
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2025
Last Update Date : 01/03/2025

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Directions to “ JACLYN UNTRECHT SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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