Provider Demographics
NPI:1043895428
Name:GROENEWOUD, JACLYN NEESE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:NEESE
Last Name:GROENEWOUD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MONTAUGUE ST
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8328
Mailing Address - Country:US
Mailing Address - Phone:828-483-2339
Mailing Address - Fax:
Practice Address - Street 1:2360 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2030
Practice Address - Country:US
Practice Address - Phone:828-274-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist