Provider Demographics
NPI:1477541308
Name:PATTON, JACALYN B (MSPA)
Entity Type:Individual
Prefix:MS
First Name:JACALYN
Middle Name:B
Last Name:PATTON
Suffix:
Gender:F
Credentials:MSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GLENEAGLES LN
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3121
Mailing Address - Country:US
Mailing Address - Phone:210-862-7975
Mailing Address - Fax:
Practice Address - Street 1:21 GLENEAGLES LN
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3121
Practice Address - Country:US
Practice Address - Phone:210-862-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50433237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50433OtherSTATE LICENSE
TXS05341Medicare UPIN