Provider Demographics
NPI:1003094954
Name:WARD, JAN C (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:WARD
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75902-0952
Mailing Address - Country:US
Mailing Address - Phone:936-639-3007
Mailing Address - Fax:936-639-3012
Practice Address - Street 1:360 NORTH JOHN REDDITT DRIVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2622
Practice Address - Country:US
Practice Address - Phone:936-639-3007
Practice Address - Fax:936-639-3012
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist