Provider Demographics
NPI:1326817057
Name:LARGENT, JACI LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACI
Middle Name:LYNN
Last Name:LARGENT
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 1:3649 CEDAR RUN RD APT 807
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2480
Mailing Address - Country:US
Mailing Address - Phone:817-776-2860
Mailing Address - Fax:
Practice Address - Street 1:6401 DIRECTORS PKWY
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5881
Practice Address - Country:US
Practice Address - Phone:325-691-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist