=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326817057
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACI LYNN LARGENT CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2023
-----------------------------------------------------
Last Update Date | 12/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6401 DIRECTORS PKWY
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79606-5881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-691-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3649 CEDAR RUN RD APT 807
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79606-2480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-776-2860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 119670
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------