Active NPI
Jaclyn Wallace
- Speech-Language Pathologist
- Austin, TX
National Provider Identifier
1609189315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 105397
- Practice address
- 2124 E Saint Elmo Rd
Austin, TX 78744-1050 - Phone
- (512) 300-0895
- NPI assigned
- Jul 22, 2010
- Last updated
- Aug 17, 2026
- 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 | 105397 | TX | Primary |
Addresses
Primary practice location
2124 E Saint Elmo Rd
Austin, TX 78744-1050
Mailing address
5520 Cherokee Draw Rd
Austin, TX 78738-4078
Phone (214) 864-9863
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105397 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kidtherapy, PLLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786924800000",
"number": "1609189315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5520 CHEROKEE DRAW RD",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787384078",
"telephone_number": "214-864-9863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2124 E SAINT ELMO RD",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787441050",
"telephone_number": "512-300-0895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JACLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-22",
"last_updated": "2026-08-17",
"certification_date": "2026-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "105397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.