Provider Demographics
NPI:1851026603
Name:KINCAID, JACQUELINE OLVERA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:OLVERA
Last Name:KINCAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:LUQUES
Other - Last Name:OLVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26180 CORTE TECOLOTE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-6576
Mailing Address - Country:US
Mailing Address - Phone:951-692-6118
Mailing Address - Fax:
Practice Address - Street 1:43900 MAYBERRY AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-6634
Practice Address - Country:US
Practice Address - Phone:961-927-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist