Provider Demographics
NPI:1548325525
Name:MCDONALD, JACKLYN ZASTROW (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:ZASTROW
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:
Other - Last Name:ZASTROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-1512
Mailing Address - Country:US
Mailing Address - Phone:208-634-8030
Mailing Address - Fax:
Practice Address - Street 1:1010 STATE ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-3704
Practice Address - Country:US
Practice Address - Phone:208-634-5909
Practice Address - Fax:208-634-5956
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP1321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12057142OtherASHA