Provider Demographics
NPI:1992118699
Name:MCCLYMONT, JACLYN (MA SLP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:MCCLYMONT
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6214
Mailing Address - Country:US
Mailing Address - Phone:330-842-2697
Mailing Address - Fax:
Practice Address - Street 1:10245 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3341
Practice Address - Country:US
Practice Address - Phone:330-748-4807
Practice Address - Fax:330-266-7513
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 225100000X, 225200000X, 225X00000X
OHSP 10806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist