Provider Demographics
NPI:1720342447
Name:SUCHECKI, JACLYN (SLP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SUCHECKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:945 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1805
Mailing Address - Country:US
Mailing Address - Phone:231-737-4374
Mailing Address - Fax:231-830-9196
Practice Address - Street 1:945 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-1805
Practice Address - Country:US
Practice Address - Phone:231-737-4374
Practice Address - Fax:231-830-9196
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist