Provider Demographics
NPI:1942361126
Name:HOWARD, JACKIE ANN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:ANN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E MULE TRAIN TRL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85243-5612
Mailing Address - Country:US
Mailing Address - Phone:480-626-0928
Mailing Address - Fax:
Practice Address - Street 1:175 W ELLIOT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5446
Practice Address - Country:US
Practice Address - Phone:480-892-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist