Individual
CALLIE JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6162 E. MOCKINGBIRD LANE, SUITE 100, DALLAS, TX 75214
(214) 824-6400
Mailing address
6162 E MOCKINGBIRD LN, SUITE 100, DALLAS, TX 75214-2697
(214) 824-6400
(214) 824-6070
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
80684
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180895801
—
TX
Enumeration date
08/26/2015
Last updated
08/26/2015
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