| Doctor Name: | CALLIE JACK |
| NPI Number: | 1093182057 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 80684 |
| Business Practice Address: | 6162 E. Mockingbird Lane Suite 100 Dallas, TX - 75214 |
| Business Phone Number: | 2148246400 |
| Business Fax Number: | |
| Mailing Address: | 6162 E Mockingbird Ln, Suite 100 DALLAS |
| State: | TX |
| Postal Code: | 752142697 |
| Phone Number: | 2148246400 |
| Fax Number: | 2148246070 |
| NPI Enumeration Date: | 08/26/2015 |
| NPI Last Update Date: | 08/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237600000X |
| License Number: | 80684 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Audiologist-Hearing Aid Fitter |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of tests to determine the exact nature of an individual |