Provider Demographics
NPI:1043015985
Name:PARDO, JACQUELINE J (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:PARDO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HUNTINGTON DR # 102
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2345
Mailing Address - Country:US
Mailing Address - Phone:626-460-0281
Mailing Address - Fax:
Practice Address - Street 1:415 HUNTINGTON DR # 102
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2345
Practice Address - Country:US
Practice Address - Phone:626-460-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist