Jaclyn Beth Brede, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

106166 Issued in TX

Practice address

605 E 7TH St
Prosper, TX 75078-2545

Phone

(469) 219-2000

NPI assigned

Aug 12, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Keystone Pediatric Therapy, PLLC

  • Speech-Language Pathologist
  • McKinney, TX
  • NPI 1629373295
  NPD (past)

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

{
    "created_epoch": "1250035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1699907592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5237 FRINGETREE DR",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750718366",
            "telephone_number": "214-728-8673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 E 7TH ST",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750782545",
            "telephone_number": "469-219-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2720 Virginia Pkwy",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "McKinney",
            "state": "TX",
            "postal_code": "750714916",
            "country_code": "US",
            "telephone_number": "972-548-1990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BREDE",
        "first_name": "JACLYN",
        "middle_name": "BETH",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-12",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "106166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brain & Body Boost, LLC
• Calaiah Branch
• Madison Branch
• Breauna Braxton
• Sintu Brayen, APRN,FNP-C
• Emily Brewer
• Sydney C Brooks, LPC
• Shiquena Brown
• Susan Sawicki Brown, M.S., CCC-SLP
• Athena Nichole Brownlee

• Speech-Language Pathologist in Prosper, TX
• Providers in Prosper, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.