Provider Demographics
NPI:1508380320
Name:TUCKER, JERRICA (AU D)
Entity Type:Individual
Prefix:
First Name:JERRICA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:JERRICA
Other - Middle Name:
Other - Last Name:BOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER RD STE 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:800-876-1456
Practice Address - Street 1:4351 BOOTH CALLOWAY RD STE 308
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7380
Practice Address - Country:US
Practice Address - Phone:817-595-3700
Practice Address - Fax:817-595-3701
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80844231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist