Provider Demographics
NPI:1427220094
Name:JAQUES, JOSELYNNE YVETTE (MSC, S-LP (CCC))
Entity Type:Individual
Prefix:MRS
First Name:JOSELYNNE
Middle Name:YVETTE
Last Name:JAQUES
Suffix:
Gender:F
Credentials:MSC, S-LP (CCC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FORTUNA W
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1848
Mailing Address - Country:US
Mailing Address - Phone:714-235-3053
Mailing Address - Fax:
Practice Address - Street 1:10 FORTUNA W
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1848
Practice Address - Country:US
Practice Address - Phone:714-235-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist