Jaclin K Proctor, M.A., CCC-A

Primary specialty

AudiologistTaxonomy code 231H00000X

License

23000412A Issued in IN

Practice address

99 E 86TH Ave
Suite a
Merrillville, IN 46410-6381

Phone

(219) 738-2528

Fax

(219) 756-7825

NPI assigned

Nov 29, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1972670636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E 86TH AVE",
            "address_2": "SUITE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106381",
            "telephone_number": "219-738-2528",
            "fax_number": "219-756-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 E 86TH AVE",
            "address_2": "SUITE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106381",
            "telephone_number": "219-738-2528",
            "fax_number": "219-756-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "JACLIN",
        "middle_name": "K",
        "credential": "M.A., CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IN",
            "license": "23000412A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100466390A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Audiologist in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Audiologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.