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General NPI Number Information
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NPI Number | 1114648409
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Entity Type | Individual
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Provider Name | JACLYN BROOKE MYERS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 14401 SPRING OAK DR
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City | MESQUITE
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State | TX
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Zip | 75180-3540
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Country | US
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Telephone | 972-571-9277
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Fax |
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Provider Business Mailing Address
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Address Line | 748 AVALON DR
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City | HEATH
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State | TX
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Zip | 75032-2061
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 113733
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License Number State | TX
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