Provider Demographics
NPI:1942971106
Name:WALDEN, JAYCIE LEA (MS SLP)
Entity Type:Individual
Prefix:
First Name:JAYCIE
Middle Name:LEA
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CLEVER
Mailing Address - State:MO
Mailing Address - Zip Code:65631-7101
Mailing Address - Country:US
Mailing Address - Phone:417-860-6020
Mailing Address - Fax:
Practice Address - Street 1:1756 BEE CREEK RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9395
Practice Address - Country:US
Practice Address - Phone:417-336-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021039373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist