Provider Demographics
NPI:1871827741
Name:MASON, JACKLYN HIGH (MA)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:HIGH
Last Name:MASON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:JOYCE
Other - Last Name:HIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:53 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-2035
Mailing Address - Country:US
Mailing Address - Phone:413-783-4122
Mailing Address - Fax:
Practice Address - Street 1:358 N PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9296
Practice Address - Country:US
Practice Address - Phone:413-545-2565
Practice Address - Fax:413-545-0803
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist