Jacqueline Jardine
Individual provider Active NPI Speech-Language Pathologist · Cottonwood, CA
NPI 1750170957 · NPPES record last updated May 5, 2025
Key facts
- NPI
- 1750170957
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 22900 (CA)
- Practice address
- 19070 Agnew Ave
Cottonwood, CA 96022-9622 - Phone
- (530) 276-4944
- NPI assigned
- May 5, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22900 | CA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22900 | CA | Yes |
Addresses
Primary practice location
19070 Agnew Ave
Cottonwood, CA 96022-9622
Mailing address
19070 Agnew Ave
Cottonwood, CA 96022-9622
Phone (530) 276-4944
Other names
- Jacqueline Straub
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All providers in Cottonwood, CA · Speech-Language Pathologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.