Provider Demographics
NPI:1922298736
Name:BALLARD, JACQUELYNN RENE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYNN
Middle Name:RENE
Last Name:BALLARD
Suffix:
Gender:F
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 1:1726 SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4934
Mailing Address - Country:US
Mailing Address - Phone:325-665-8778
Mailing Address - Fax:
Practice Address - Street 1:2616 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1557
Practice Address - Country:US
Practice Address - Phone:325-665-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist