Provider Demographics
NPI:1689398984
Name:WARRICK, JATIA LYNN (SLP-A)
Entity Type:Individual
Prefix:
First Name:JATIA
Middle Name:LYNN
Last Name:WARRICK
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 LOST TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3228
Mailing Address - Country:US
Mailing Address - Phone:210-245-0286
Mailing Address - Fax:
Practice Address - Street 1:2186 LOST TIMBERS DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3228
Practice Address - Country:US
Practice Address - Phone:210-245-0286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant