Provider Demographics
NPI:1699907592
Name:BREDE, JACLYN BETH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:BETH
Last Name:BREDE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5237 FRINGETREE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-8366
Mailing Address - Country:US
Mailing Address - Phone:214-728-8673
Mailing Address - Fax:
Practice Address - Street 1:605 E 7TH ST
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2545
Practice Address - Country:US
Practice Address - Phone:469-219-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist