Individual
JACQUELYN MARIE FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
3265 BIDDLE RD, MEDFORD, OR 97504-4122
(541) 816-4747
Mailing address
63 LARKFIELD MAPLES CT, SANTA ROSA, CA 95403-1486
(530) 859-3117
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
016472
OR
235Z00000X
Speech-Language Pathologist
27301
CA
Other
Enumeration date
03/26/2019
Last updated
03/26/2019
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