MEDICARE: JACQUELINE NICOLE PHILLIPS M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	113608	TX

General Provider Information

NPI Number	:	1316459415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE NICOLE PHILLIPS M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	5000 TRENTON DR
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3109
Country	:	US
Telephone Number	:	903-780-3505
Fax Number	:	877-798-4959

Provider Business Practice Location Address
First Line	:	3310 S BROADWAY AVE STE 100I
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-7818
Country	:	US
Telephone Number	:	903-781-1832
Fax Number	:	877-798-4959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	02/26/2026

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Directions to “ JACQUELINE NICOLE PHILLIPS M.A. CCC-SLP” Practice Location

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