Active NPI
Jacqueline Rae Brock, M.S, CCC-SLP
- Speech-Language Pathologist
- Hebron, KY
National Provider Identifier
1215222781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 106170
- Practice address
- 2605 Bethlehem LN
Hebron, KY 41048-9714 - Phone
- (281) 845-1902
- NPI assigned
- Jun 13, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 106170 | TX | Primary |
Addresses
Primary practice location
2605 Bethlehem LN
Hebron, KY 41048-9714
Mailing address
2605 Bethlehem LN
Hebron, KY 41048-9714
Phone (281) 845-1902
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106170 | TX | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1215222781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2605 BETHLEHEM LN",
"city": "HEBRON",
"state": "KY",
"postal_code": "410489714",
"telephone_number": "281-845-1902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2605 BETHLEHEM LN",
"city": "HEBRON",
"state": "KY",
"postal_code": "410489714",
"telephone_number": "281-845-1902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "JACQUELINE",
"middle_name": "RAE",
"credential": "M.S, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-13",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "106170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hebron, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.