Provider Demographics
NPI:1821613654
Name:SIEBENALER, JACKALYN PATRICIA
Entity Type:Individual
Prefix:MISS
First Name:JACKALYN
Middle Name:PATRICIA
Last Name:SIEBENALER
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 1:2030 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-9324
Mailing Address - Country:US
Mailing Address - Phone:419-518-0267
Mailing Address - Fax:
Practice Address - Street 1:2030 JERICHO RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-9324
Practice Address - Country:US
Practice Address - Phone:419-518-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program