Provider Demographics
NPI:1508306796
Name:ROMERO, JACQUELINE GAZELLE (SLP ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:GAZELLE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 HALLMARK CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-1217
Mailing Address - Country:US
Mailing Address - Phone:915-920-7804
Mailing Address - Fax:
Practice Address - Street 1:4601 HONDO PASS DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904
Practice Address - Country:US
Practice Address - Phone:915-920-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377282355S0801X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant