Healthcare Provider Details

I. General information

NPI: 1730910092
Provider Name (Legal Business Name): CHRISTINE JAKUTA MS-CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10127 MOROCCO ST
SAN ANTONIO TX
78216-3943
US

IV. Provider business mailing address

3335 FLAMINGO BASIN
SAN ANTONIO TX
78247-6514
US

V. Phone/Fax

Practice location:
  • Phone: 210-838-5351
  • Fax:
Mailing address:
  • Phone: 915-373-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15763
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: