Provider Demographics
NPI:1023278843
Name:LOVITT, JACQUELYN CLARINE JACKSON (AUD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:CLARINE JACKSON
Last Name:LOVITT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11886 HEALING WAY STE 530
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7917
Mailing Address - Country:US
Mailing Address - Phone:240-670-1200
Mailing Address - Fax:240-719-0534
Practice Address - Street 1:11886 HEALING WAY STE 530
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7917
Practice Address - Country:US
Practice Address - Phone:240-670-1200
Practice Address - Fax:240-719-0534
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD319007200Medicaid