Provider Demographics
NPI:1558613893
Name:GREGG, JACLYN A (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:A
Last Name:GREGG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOGANS WAY
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3402
Mailing Address - Country:US
Mailing Address - Phone:845-897-3330
Mailing Address - Fax:
Practice Address - Street 1:6 LOGANS WAY
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3402
Practice Address - Country:US
Practice Address - Phone:845-897-3330
Practice Address - Fax:845-897-3753
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023129-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist