Healthcare Provider Details

I. General information

NPI: 1205709391
Provider Name (Legal Business Name): JACQRE M STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 FM 359 RD STE S
RICHMOND TX
77406-2050
US

IV. Provider business mailing address

4211 PATHWAY CT
FRESNO TX
77545-7559
US

V. Phone/Fax

Practice location:
  • Phone: 281-232-1900
  • Fax:
Mailing address:
  • Phone: 281-431-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number44272
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: