Provider Demographics
NPI:1811625213
Name:WASHER, JACQUELINE COLLEEN
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:COLLEEN
Last Name:WASHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74733-0151
Mailing Address - Country:US
Mailing Address - Phone:580-775-5510
Mailing Address - Fax:
Practice Address - Street 1:321 S 2ND ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4701
Practice Address - Country:US
Practice Address - Phone:903-583-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist