Provider Demographics
NPI:1790260560
Name:TREVINO, JESSICA LYNETTE GARCIA (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNETTE GARCIA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MS CCC/SLP
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Mailing Address - Street 1:606 COYOTE TRL
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4004
Mailing Address - Country:US
Mailing Address - Phone:361-664-5479
Mailing Address - Fax:361-664-3561
Practice Address - Street 1:606 COYOTE TRL
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4004
Practice Address - Country:US
Practice Address - Phone:361-664-5479
Practice Address - Fax:361-664-3561
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX101111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist