Provider Demographics
NPI:1013489046
Name:JARVIE, JACLYN BRIDGES (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:BRIDGES
Last Name:JARVIE
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 1:203 HILL ST
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1024
Mailing Address - Country:US
Mailing Address - Phone:724-516-0349
Mailing Address - Fax:
Practice Address - Street 1:1050 CORPORATE LN STE H
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-8905
Practice Address - Country:US
Practice Address - Phone:412-223-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist