Individual
MRS. M ELIZABETH JAECKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPA
Contact information
Practice address
2003 PATTERSON DR, VICTORIA, TX 77901-5645
(361) 575-5021
(361) 575-0623
Mailing address
2003 PATTERSON DR, VICTORIA, TX 77901-5645
(361) 575-5021
(361) 575-0623
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
14755
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8001BH
BLUE CROSS BLUE SHIELD
TX
Enumeration date
02/13/2007
Last updated
07/08/2007
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