Provider Demographics
NPI:1003105545
Name:MCCLAIN, JENCY MIGNON (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:JENCY
Middle Name:MIGNON
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:MIGNON
Other - Middle Name:D'ARMOND
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:5757 WOODWAY DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1514
Mailing Address - Country:US
Mailing Address - Phone:713-787-5015
Mailing Address - Fax:713-787-5032
Practice Address - Street 1:5757 WOODWAY DR
Practice Address - Street 2:SUITE 125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1514
Practice Address - Country:US
Practice Address - Phone:713-787-5015
Practice Address - Fax:713-787-5032
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist