Provider Demographics
NPI:1295459642
Name:JACINTO, SUSAN KAY
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:JACINTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GEORGE SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ITALY
Mailing Address - State:TX
Mailing Address - Zip Code:76651-3691
Mailing Address - Country:US
Mailing Address - Phone:972-935-2187
Mailing Address - Fax:
Practice Address - Street 1:301 E 5TH ST
Practice Address - Street 2:
Practice Address - City:FERRIS
Practice Address - State:TX
Practice Address - Zip Code:75125-2225
Practice Address - Country:US
Practice Address - Phone:972-544-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist