Most Relevant Information
Provider Data
| NPI Number: | 1003370578 |
| Provider Name: | JACKLYN EWALD LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | C.1902396 |
Most Important Dates
| Enumeration Date: | 01/29/2019 |
| Last Updated: | 07/01/2020 |
Provider Practice Location
601 SOUTH EDWIN C MOSES BLVD
DAYTON
OH
45417
Practice Location Phone/Fax
| Phone: | 9377348333 |
| Fax: |
Provider Mailing Location
601 SOUTH EDWIN C MOSES BLVD
DAYTON
OH
45417
Provider Mailing Phone/Fax
| Phone: | 9377348333 |
| Fax: |