Provider Demographics
NPI:1295262640
Name:ECKLUND, JAIMIE DARLENE (SLP ASSISTANT)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:DARLENE
Last Name:ECKLUND
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MAJOR ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2214
Mailing Address - Country:US
Mailing Address - Phone:361-652-5359
Mailing Address - Fax:
Practice Address - Street 1:2700 EARL RUDDER FWY S STE 1200
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-2810
Practice Address - Country:US
Practice Address - Phone:979-307-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX384582355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant