Jacqueline Rene McClure, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146-004662 Issued in IL

Practice address

275 South University Street
211 Rachel Cooper
Normal, IL 61761

Phone

(309) 438-8641

Fax

(309) 438-5221

NPI assigned

Aug 13, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Jacqueline Rene Bullard Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Illinois State UniversityGroup PAC ID 5597088492, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Illinois State University

  • Audiologist-Hearing Aid Fitter
  • Normal, IL
  • NPI 1669616983
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1003163676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ECKELMANN TAYLOR SPEECH AND HEARING CLINIC",
            "address_2": "CAMPUS BOX 4720",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617904720",
            "telephone_number": "309-438-8641",
            "fax_number": "309-438-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SOUTH UNIVERSITY STREET",
            "address_2": "211 RACHEL COOPER",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "61761",
            "telephone_number": "309-438-8641",
            "fax_number": "309-438-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLURE",
        "first_name": "JACQUELINE",
        "middle_name": "RENE",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146-004662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "BULLARD",
            "middle_name": "RENE",
            "prefix": "MISS",
            "credential": "M.S., CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Matthews, APN
• Daniel Lee Maurer
• Lindsay Marie Maxson, DSW, LCSW
• Poonam C McAllister, PT
• Elisabeth Leann McClure, FNP APN
• Scott McCormick III, M.D.
• Kelli McCubbins, PHARMD
• Julie Marie McDaniel
• Ryanne McDaniel
• Sue S McGinnes, APN, CNP

• Speech-Language Pathologist in Normal, IL
• Providers in Normal, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.