Basic Information
| Provider Information | |||||||||
| NPI: | 1164868725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEMPLE | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, CCC-SLP/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3585 BRAMBLETON AVE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240186521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407761029 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3585 BRAMBLETON AVE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240186521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407761029 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202005919 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.