Provider Demographics
NPI:1245454107
Name:JACQUES, JEANETTE MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:MARIE
Last Name:JACQUES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10532 67TH AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10532 67TH AVE
Practice Address - Street 2:APT. B
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6422
Practice Address - Country:US
Practice Address - Phone:623-555-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist