Provider Demographics
NPI:1437872579
Name:HURBANIS, JACQUELINE BARON
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BARON
Last Name:HURBANIS
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 1:12002 VIA SIENA LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7442
Mailing Address - Country:US
Mailing Address - Phone:281-731-0130
Mailing Address - Fax:
Practice Address - Street 1:11750 STEEPLE WAY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4366
Practice Address - Country:US
Practice Address - Phone:281-897-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15744235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty