Individual
JACKIE HAVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1402 W PICO AVE STE A30, EL CENTRO, CA 92243-1377
(760) 259-5316
Mailing address
1499 N 12TH ST, EL CENTRO, CA 92243-1375
(760) 259-5316
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
33848
CA
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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