Provider Demographics
NPI:1154848059
Name:KOWALONEK, JACLYN MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:KOWALONEK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WESTON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3616
Mailing Address - Country:US
Mailing Address - Phone:954-389-1414
Mailing Address - Fax:954-389-4201
Practice Address - Street 1:2500 WESTON RD STE 103
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3616
Practice Address - Country:US
Practice Address - Phone:954-389-1414
Practice Address - Fax:954-389-4201
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2124231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist