Provider Demographics
NPI:1285927202
Name:EATON, JACLYN CAMMISO (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:CAMMISO
Last Name:EATON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:CAMMISO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 MILYKO DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1039
Mailing Address - Country:US
Mailing Address - Phone:720-442-3679
Mailing Address - Fax:
Practice Address - Street 1:21 MILYKO DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1039
Practice Address - Country:US
Practice Address - Phone:720-442-3679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist