Provider Demographics
NPI:1306565379
Name:HARRISON, JACLYN HAYLEY
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:HAYLEY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BAY RIDGE PKWY APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2352
Mailing Address - Country:US
Mailing Address - Phone:347-831-4243
Mailing Address - Fax:
Practice Address - Street 1:154 BAY RIDGE PKWY APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2352
Practice Address - Country:US
Practice Address - Phone:347-831-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist