Provider Demographics
NPI:1104618800
Name:FITZPATRICK, JACLYN W (SLPA)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:W
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 178TH AVE E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6411
Mailing Address - Country:US
Mailing Address - Phone:502-608-2704
Mailing Address - Fax:
Practice Address - Street 1:1320 178TH AVE E
Practice Address - Street 2:
Practice Address - City:LAKE TAPPS
Practice Address - State:WA
Practice Address - Zip Code:98391-6411
Practice Address - Country:US
Practice Address - Phone:502-608-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant