Provider Demographics
NPI:1801146501
Name:PROTEXTER, JACULIN (MA)
Entity type:Individual
Prefix:
First Name:JACULIN
Middle Name:
Last Name:PROTEXTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 WOODRIVER DR
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-5224
Mailing Address - Country:US
Mailing Address - Phone:605-280-7510
Mailing Address - Fax:
Practice Address - Street 1:1118 WOODRIVER DR
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-5224
Practice Address - Country:US
Practice Address - Phone:605-280-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD01090900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist