Individual
SASHA D. JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1600 W 38TH ST, STE 212, AUSTIN, TX 78731-6400
(512) 324-3315
(512) 324-3314
Mailing address
4616 W HOWARD LN, AUSTIN, TX 78728-6300
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
36838
TX
103TC0700X
Clinical Psychologist
7266
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364584801
—
TX
05
—
364584802
—
TX
Enumeration date
08/27/2010
Last updated
03/27/2017
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