Provider Demographics
NPI:1679903926
Name:GRETSKY, JACLYN (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:GRETSKY
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 1:11 DONNA CIR
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8876
Mailing Address - Country:US
Mailing Address - Phone:570-385-4252
Mailing Address - Fax:
Practice Address - Street 1:44 DONALDSON RD
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:PA
Practice Address - Zip Code:17981-1424
Practice Address - Country:US
Practice Address - Phone:570-695-3141
Practice Address - Fax:570-695-2264
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist