Provider Demographics
NPI:1952505950
Name:MCQUERRY, JODY RENEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:RENEE
Last Name:MCQUERRY
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 1:4744 AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-3328
Mailing Address - Country:US
Mailing Address - Phone:940-757-0066
Mailing Address - Fax:
Practice Address - Street 1:910 MIDWESTERN PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2210
Practice Address - Country:US
Practice Address - Phone:940-235-4028
Practice Address - Fax:940-235-4018
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist