Provider Demographics
NPI:1659850089
Name:HEAD, JASON DOUGLAS (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DOUGLAS
Last Name:HEAD
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 HIGH GLEN CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2041
Mailing Address - Country:US
Mailing Address - Phone:318-366-7825
Mailing Address - Fax:
Practice Address - Street 1:9250 HUMBLE WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4247
Practice Address - Country:US
Practice Address - Phone:281-446-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist