Individual
JACLYN GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6622 AVALON FOREST DR, INDIANAPOLIS, IN 46250-2804
(567) 239-2514
Mailing address
12505 BENTLEY BLVD, FISHERS, IN 46038-1223
(567) 239-2514
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
10/14/2024
Last updated
10/14/2024
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