Provider Demographics
NPI:1184009060
Name:CHARIE, JACLYN ASHLEY
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:ASHLEY
Last Name:CHARIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2653
Mailing Address - Country:US
Mailing Address - Phone:412-722-6271
Mailing Address - Fax:
Practice Address - Street 1:420 E NORTH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4746
Practice Address - Country:US
Practice Address - Phone:421-722-6271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist