Provider Demographics
NPI:1487249702
Name:CONRAD, JACLYN (MS, NCC)
Entity type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 4TH AVE FL 18
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1706
Mailing Address - Country:US
Mailing Address - Phone:412-532-1249
Mailing Address - Fax:
Practice Address - Street 1:19 N BACTON HILL RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1005
Practice Address - Country:US
Practice Address - Phone:412-532-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC015505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health