Provider Demographics
NPI:1104595982
Name:WETTLIN, JAYNA MEYER (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JAYNA
Middle Name:MEYER
Last Name:WETTLIN
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 LOG SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5012
Mailing Address - Country:US
Mailing Address - Phone:864-275-8956
Mailing Address - Fax:
Practice Address - Street 1:128 GARNER RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3149
Practice Address - Country:US
Practice Address - Phone:864-591-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty