Provider Demographics
NPI:1598903460
Name:LESTER, JACQUELYN ANN (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ANN
Last Name:LESTER
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:ANN
Other - Last Name:MCNEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:1400 SH 360
Mailing Address - Street 2:APT. #2318
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3509
Mailing Address - Country:US
Mailing Address - Phone:903-277-8858
Mailing Address - Fax:
Practice Address - Street 1:1400 SH 360
Practice Address - Street 2:APT. #2318
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3509
Practice Address - Country:US
Practice Address - Phone:903-277-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist