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NPI Code Detail

MEDICARE: MS. MCKENNA JASEK MS, CCC/SLP

MEDICARE: MS. MCKENNA JASEK MS, 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
1235Z00000XSpeech-Language Pathologist118115TX

General Provider Information

NPI Number : 1588302087
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MCKENNA JASEK MS, CCC/SLP
Provider Business Mailing Address
First Line : 411 SUMMIT ST
Second Line :
City : SCHULENBURG
State : TX
Zip : 78956-1532
Country : US
Telephone Number : 979-743-2108
Fax Number : 979-743-2109
Provider Business Practice Location Address
First Line : 411 SUMMIT ST
Second Line :
City : SCHULENBURG
State : TX
Zip : 78956-1532
Country : US
Telephone Number : 979-743-2108
Fax Number : 979-743-2109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2022
Last Update Date : 05/24/2022

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