Provider Demographics
NPI:1588302087
Name:JASEK, MCKENNA (MS, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:MCKENNA
Middle Name:
Last Name:JASEK
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 1:411 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-1532
Mailing Address - Country:US
Mailing Address - Phone:979-743-2108
Mailing Address - Fax:979-743-2109
Practice Address - Street 1:411 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1532
Practice Address - Country:US
Practice Address - Phone:979-743-2108
Practice Address - Fax:979-743-2109
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist