Provider Demographics
NPI:1811378839
Name:BEWICK, JACLYN (AUD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:BEWICK
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 1:3 W OLIVE ST
Mailing Address - Street 2:STE 106
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2573
Mailing Address - Country:US
Mailing Address - Phone:410-647-7795
Mailing Address - Fax:410-315-8823
Practice Address - Street 1:580 RITCHIE HWY
Practice Address - Street 2:SUITE I
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3924
Practice Address - Country:US
Practice Address - Phone:410-647-7795
Practice Address - Fax:410-315-8823
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006453231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist