Provider Demographics
NPI:1306150065
Name:HARRIS, JACLYN N (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:N
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17503 BRYCE MANOR LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-6216
Mailing Address - Country:US
Mailing Address - Phone:281-812-9519
Mailing Address - Fax:281-812-5719
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5139
Practice Address - Country:US
Practice Address - Phone:281-812-9519
Practice Address - Fax:281-812-5719
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist