Individual
JAYLA RENAE EAGLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC/SLP
Contact information
Practice address
3502 UNIVERSITY DR S, FARGO, ND 58104-6228
(701) 446-3934
Mailing address
415 4TH ST N, FARGO, ND 58102-4514
(701) 446-1034
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1046
ND
Other
Enumeration date
11/04/2008
Last updated
08/06/2018
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