Provider Demographics
NPI:1386372381
Name:RICHMOND-GAYTAN, JANNETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANNETTE
Middle Name:
Last Name:RICHMOND-GAYTAN
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 1:27156 PERK LN
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-1888
Mailing Address - Country:US
Mailing Address - Phone:956-456-2978
Mailing Address - Fax:
Practice Address - Street 1:240 N CROCKETT ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4608
Practice Address - Country:US
Practice Address - Phone:956-361-6221
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
TX104135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist