Provider Demographics
NPI:1003158494
Name:FLICKINGER, JACLYN (DO)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:FLICKINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:FLICKINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:121 NORTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278
Mailing Address - Country:US
Mailing Address - Phone:330-633-1350
Mailing Address - Fax:330-633-6068
Practice Address - Street 1:121 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1809
Practice Address - Country:US
Practice Address - Phone:330-633-1350
Practice Address - Fax:330-633-6068
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-012610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology