Provider Demographics
NPI:1023463072
Name:MALVAROSA, JACLYNN
Entity type:Individual
Prefix:
First Name:JACLYNN
Middle Name:
Last Name:MALVAROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6678 ANNABELLA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-8141
Mailing Address - Country:US
Mailing Address - Phone:845-416-0599
Mailing Address - Fax:
Practice Address - Street 1:145 NASHVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1823
Practice Address - Country:US
Practice Address - Phone:845-416-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist