Provider Demographics
NPI:1871850115
Name:BAXENDALE, JACALYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:
Last Name:BAXENDALE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JACALYN
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:106 BOUNDARY LN
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2616
Mailing Address - Country:US
Mailing Address - Phone:856-701-3117
Mailing Address - Fax:
Practice Address - Street 1:29000 INFORMATION LN STE 507
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7032
Practice Address - Country:US
Practice Address - Phone:410-822-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010169235Z00000X
NJ41YS00658900235Z00000X
MD08237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist