Provider Demographics
NPI:1801347380
Name:GARGIULO, JACQUELYN EILEEN (AUD)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:EILEEN
Last Name:GARGIULO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-4116
Mailing Address - Country:US
Mailing Address - Phone:631-994-6604
Mailing Address - Fax:
Practice Address - Street 1:2101 STATE HILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1993
Practice Address - Country:US
Practice Address - Phone:484-628-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006488231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist