Provider Demographics
NPI:1861627390
Name:JACASZEK, JILL YVONNE (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:YVONNE
Last Name:JACASZEK
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1051 AUGUSTA CIR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3147
Mailing Address - Country:US
Mailing Address - Phone:724-864-3793
Mailing Address - Fax:
Practice Address - Street 1:5500 BROOKTREE RD
Practice Address - Street 2:REHABCARE GROUP EAST INC.
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090
Practice Address - Country:US
Practice Address - Phone:724-940-3468
Practice Address - Fax:724-940-3969
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist