Provider Demographics
NPI:1962836056
Name:STEIN, JACLYNN BROOKE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACLYNN
Middle Name:BROOKE
Last Name:STEIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 ALIIOLANI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8314
Mailing Address - Country:US
Mailing Address - Phone:808-446-6167
Mailing Address - Fax:808-579-8049
Practice Address - Street 1:368 ALIIOLANI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8314
Practice Address - Country:US
Practice Address - Phone:808-446-6167
Practice Address - Fax:808-579-8049
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#8727235Z00000X
HI1547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist