Provider Demographics
NPI:1275305427
Name:SWEETRA, JACLYN NICOLE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:NICOLE
Last Name:SWEETRA
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:NICOLE
Other - Last Name:SWEETRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:606 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1043
Mailing Address - Country:US
Mailing Address - Phone:570-316-1054
Mailing Address - Fax:
Practice Address - Street 1:189 E TRESSLER BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9272
Practice Address - Country:US
Practice Address - Phone:570-524-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty