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General NPI Number Information
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NPI Number | 1043016819
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Entity Type | Individual
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Provider Name | JENNIFER LEE CARLILE SLPA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 2011 BROADWAY ST STE 130
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City | PEARLAND
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State | TX
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Zip | 77581-5945
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Country | US
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Telephone | 210-888-0368
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Fax |
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Provider Business Mailing Address
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Address Line | 370 BACKACRE RD
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City | KERRVILLE
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State | TX
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Zip | 78028-8549
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Country | US
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Telephone | 830-928-2318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 44158
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License Number State | TX
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