Provider Demographics
NPI:1932666914
Name:BERNET, JACLYN (SLP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:BERNET
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:MACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5825 GLENRIDGE DR STE 133
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:678-733-9318
Mailing Address - Fax:404-902-5440
Practice Address - Street 1:5825 GLENRIDGE DR STE 133
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:678-733-9318
Practice Address - Fax:404-902-5440
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist