Provider Demographics
NPI:1033962220
Name:LANCLOS, JAMIE A
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:LANCLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32111 DECKER PINES ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-3824
Mailing Address - Country:US
Mailing Address - Phone:713-562-4637
Mailing Address - Fax:
Practice Address - Street 1:32111 DECKER PINES ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-3824
Practice Address - Country:US
Practice Address - Phone:713-562-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist