Provider Demographics
NPI:1922113943
Name:TAYLOR-GERGEL, JACALYN ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACALYN
Middle Name:ANN
Last Name:TAYLOR-GERGEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4 GARDEN TER
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3604
Mailing Address - Country:US
Mailing Address - Phone:828-281-4098
Mailing Address - Fax:828-254-8887
Practice Address - Street 1:143 MERRIMON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1815
Practice Address - Country:US
Practice Address - Phone:828-254-8889
Practice Address - Fax:828-254-8887
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7412471Medicaid
NC136EJOtherBCBS NC