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General NPI Number Information
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NPI Number | 1578334702
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Entity Type | Individual
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Provider Name | JACKELINE CHAVEZ
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Gender | Female
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 520 18TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95811-1007
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Country | US
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Telephone | 916-395-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 27TH ST APT 10
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City | SACRAMENTO
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State | CA
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Zip | 95816-6954
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Country | US
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Telephone | 916-757-7620
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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 | 4381
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License Number State | CA
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