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NPI Code Detail

MEDICARE: ANDREA JACKOLA MS

MEDICARE: ANDREA JACKOLA MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist1003991MN

General Provider Information

NPI Number : 1346195815
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA JACKOLA MS
Provider Business Mailing Address
First Line : 5707 HIGHWAY 7 APT 335
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-5087
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1250 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2533
Country : US
Telephone Number : 612-668-0254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ ANDREA JACKOLA MS” Practice Location

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