Provider Demographics
NPI:1346243854
Name:SHILO-GRADNIGO, JACQUELINE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:SHILO-GRADNIGO
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 HIGHWAY 167
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-1227
Mailing Address - Country:US
Mailing Address - Phone:337-826-0777
Mailing Address - Fax:
Practice Address - Street 1:971 HIGHWAY 167
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-1227
Practice Address - Country:US
Practice Address - Phone:337-826-0777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist