Provider Demographics
NPI:1053517615
Name:KUCIA, JACQUELYN A (MACCC/SLP)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:A
Last Name:KUCIA
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5961
Mailing Address - Country:US
Mailing Address - Phone:216-650-1819
Mailing Address - Fax:
Practice Address - Street 1:2021 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-5961
Practice Address - Country:US
Practice Address - Phone:216-650-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5476235Z00000X
OHSP 6236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist