Provider Demographics
NPI:1306574330
Name:PICKERING, JEAN ANNE (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ANNE
Last Name:PICKERING
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 1:1001 N FM 2148
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-0363
Mailing Address - Country:US
Mailing Address - Phone:903-293-3254
Mailing Address - Fax:
Practice Address - Street 1:202 RED RIVER RD N
Practice Address - Street 2:
Practice Address - City:REDWATER
Practice Address - State:TX
Practice Address - Zip Code:75573
Practice Address - Country:US
Practice Address - Phone:903-671-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist