MEDICARE: JACQUELINE S HARDEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant		TX

General Provider Information

NPI Number	:	1467070144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE S HARDEE

Provider Business Mailing Address
First Line	:	1407 SOUTHMORE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5845
Country	:	US
Telephone Number	:	281-851-9007
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 SOUTHMORE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5845
Country	:	US
Telephone Number	:	281-851-9007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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Directions to “ JACQUELINE S HARDEE ” Practice Location

Language	Start Address	Practice Location

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