Provider Demographics
NPI:1275614190
Name:REW, JACQUELINE HERNANDEZ (M ED MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:HERNANDEZ
Last Name:REW
Suffix:
Gender:F
Credentials:M ED MS CCC SLP
Other - Prefix:
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Mailing Address - Street 1:2202 RIVA ROW APT 4109
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3145
Mailing Address - Country:US
Mailing Address - Phone:281-686-0460
Mailing Address - Fax:281-288-1081
Practice Address - Street 1:2202 RIVA ROW APT 4109
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3145
Practice Address - Country:US
Practice Address - Phone:281-686-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1200407060Medicare ID - Type Unspecified