Provider Demographics
NPI:1427257245
Name:SEGUIN, JACQUELYN RAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:RAE
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:MA, 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:HIGH PEAKS HEALTH AND FITNESS
Mailing Address - Street 2:50 SKI HILL ROAD
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422
Mailing Address - Country:US
Mailing Address - Phone:208-354-3128
Mailing Address - Fax:
Practice Address - Street 1:HIGH PEAKS HEALTH AND FITNESS
Practice Address - Street 2:50 SKI HILL ROAD
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422
Practice Address - Country:US
Practice Address - Phone:208-354-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist