Provider Demographics
NPI:1831412907
Name:JACKIE-D-YAK, LLC
Entity type:Organization
Organization Name:JACKIE-D-YAK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:REE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, CCC-SLP
Authorized Official - Phone:615-476-7261
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37011-0516
Mailing Address - Country:US
Mailing Address - Phone:615-290-5397
Mailing Address - Fax:
Practice Address - Street 1:4741 TROUSDALE DR STE 1
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1340
Practice Address - Country:US
Practice Address - Phone:615-290-5397
Practice Address - Fax:615-941-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000002334261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech