Provider Demographics
NPI:1003163676
Name:MCCLURE, JACQUELINE RENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:RENE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:RENE
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:ECKELMANN TAYLOR SPEECH AND HEARING CLINIC
Mailing Address - Street 2:CAMPUS BOX 4720
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61790-4720
Mailing Address - Country:US
Mailing Address - Phone:309-438-8641
Mailing Address - Fax:309-438-5221
Practice Address - Street 1:275 SOUTH UNIVERSITY STREET
Practice Address - Street 2:211 RACHEL COOPER
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-438-8641
Practice Address - Fax:309-438-5221
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-004662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist