Provider Demographics
NPI:1073930830
Name:PATRIZIA, JACLYN WOODYATT (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:WOODYATT
Last Name:PATRIZIA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-1304
Mailing Address - Country:US
Mailing Address - Phone:434-245-2922
Mailing Address - Fax:
Practice Address - Street 1:1562 DAIRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1304
Practice Address - Country:US
Practice Address - Phone:434-245-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist