Provider Demographics
NPI:1972020493
Name:MEYER, JACLYN SUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:SUE
Last Name:MEYER
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 1:6341 NASHWAY CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-9499
Mailing Address - Country:US
Mailing Address - Phone:402-209-2318
Mailing Address - Fax:
Practice Address - Street 1:7700 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-2944
Practice Address - Country:US
Practice Address - Phone:402-436-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist