MEDICARE: MRS. JILL E JACKSON MA, CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SP-7319	OH

General Provider Information

NPI Number	:	1649469685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL E JACKSON MA, CCC-SLP

Provider Business Mailing Address
First Line	:	3099 MEADOWBROOK BLVD
Second Line	:	#1
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2883
Country	:	US
Telephone Number	:	216-320-0879
Fax Number	:

Provider Business Practice Location Address
First Line	:	3099 MEADOWBROOK BLVD
Second Line	:	#1
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2883
Country	:	US
Telephone Number	:	216-320-0879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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Directions to “ MRS. JILL E JACKSON MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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