Provider Demographics
NPI:1053832998
Name:ROWLETT, JACLYN MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:MARIE
Last Name:ROWLETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:MARIE-ROWLETT
Other - Last Name:RENKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3260
Mailing Address - Country:US
Mailing Address - Phone:248-865-4164
Mailing Address - Fax:248-865-4128
Practice Address - Street 1:30055 NORTHWESTERN HWY STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3260
Practice Address - Country:US
Practice Address - Phone:248-865-4164
Practice Address - Fax:248-865-4128
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000779231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist