Provider Demographics
NPI:1891285532
Name:TERUYA, JACLYN SADAKO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:SADAKO
Last Name:TERUYA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:SAGUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 17945
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-0945
Mailing Address - Country:US
Mailing Address - Phone:808-387-6640
Mailing Address - Fax:
Practice Address - Street 1:1611 KEWALO ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3134
Practice Address - Country:US
Practice Address - Phone:808-387-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist