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NPI Code Detail

MEDICARE: MS. NANCY ANGELIA JACKSON MS-CCC/SLP

MEDICARE: MS. NANCY ANGELIA JACKSON MS-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
1235Z00000XSpeech-Language Pathologist100608TX

General Provider Information

NPI Number : 1730708975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY ANGELIA JACKSON MS-CCC/SLP
Provider Business Mailing Address
First Line : 2655 VILLA CREEK DR STE 140
Second Line :
City : DALLAS
State : TX
Zip : 75234-7385
Country : US
Telephone Number : 469-250-3524
Fax Number :
Provider Business Practice Location Address
First Line : 2655 VILLA CREEK DR STE 140
Second Line :
City : DALLAS
State : TX
Zip : 75234-7385
Country : US
Telephone Number : 469-250-3524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2020
Last Update Date : 04/08/2020

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Directions to “ MS. NANCY ANGELIA JACKSON MS-CCC/SLP” Practice Location

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