Provider Demographics
NPI:1396118576
Name:FLEIG, JACLYN (MCD,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:FLEIG
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 SAINT ANDREWS ROAD
Mailing Address - Street 2:SUITE A12 #261
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1137
Mailing Address - Country:US
Mailing Address - Phone:724-766-0556
Mailing Address - Fax:
Practice Address - Street 1:237 NEWPARK PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8667
Practice Address - Country:US
Practice Address - Phone:724-766-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3787235Z00000X
SC6760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist