Healthcare Provider Details

I. General information

NPI: 1699667162
Provider Name (Legal Business Name): JENNA ALEXIS NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
ALICE TX
78332-4969
US

IV. Provider business mailing address

202 TAYLOR RD
FALFURRIAS TX
78355-5210
US

V. Phone/Fax

Practice location:
  • Phone: 361-396-4029
  • Fax:
Mailing address:
  • Phone: 361-446-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number124038
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: