Provider Demographics
NPI:1285810259
Name:MAGALLAN, JACKLIN RENEE (SLP)
Entity type:Individual
Prefix:MISS
First Name:JACKLIN
Middle Name:RENEE
Last Name:MAGALLAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3330
Mailing Address - Country:US
Mailing Address - Phone:956-631-6200
Mailing Address - Fax:956-631-6433
Practice Address - Street 1:3601 BUDDY OWENS BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6447
Practice Address - Country:US
Practice Address - Phone:956-631-6200
Practice Address - Fax:956-631-6433
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2009-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist