Provider Demographics
NPI:1376097816
Name:LORRAINE, JACLYN DIANA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:DIANA
Last Name:LORRAINE
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 1:5921 KINSDALE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6806
Mailing Address - Country:US
Mailing Address - Phone:724-650-3369
Mailing Address - Fax:
Practice Address - Street 1:5921 KINSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6806
Practice Address - Country:US
Practice Address - Phone:724-650-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-13
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist