Provider Demographics
NPI:1497172910
Name:BRIGGLE, JERELEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JERELEN
Middle Name:
Last Name:BRIGGLE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JERELEN
Other - Middle Name:
Other - Last Name:FUTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1876 FARM MARKET RD 1502
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:TX
Mailing Address - Zip Code:75436
Mailing Address - Country:US
Mailing Address - Phone:903-905-2702
Mailing Address - Fax:
Practice Address - Street 1:100 E FERGUSON ST STE 1204
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5700
Practice Address - Country:US
Practice Address - Phone:903-509-2040
Practice Address - Fax:903-532-5873
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist