Provider Demographics
NPI:1407200371
Name:JAGGE, KATIE LYNN
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:JAGGE
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 1:2700 EARL RUDDER FWY S
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5010
Mailing Address - Country:US
Mailing Address - Phone:979-307-5850
Mailing Address - Fax:979-307-5858
Practice Address - Street 1:2700 EARL RUDDER FWY S
Practice Address - Street 2:SUITE 1200
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5010
Practice Address - Country:US
Practice Address - Phone:979-307-5850
Practice Address - Fax:979-307-5858
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX395792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant