Healthcare Provider Details

I. General information

NPI: 1306222013
Provider Name (Legal Business Name): JANET E. JACKSON, SLPC & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4268 CAHABA HEIGHTS CT SUITE 190 C
VESTAVIA AL
35243-5711
US

IV. Provider business mailing address

4268 CAHABA HEIGHTS CT SUITE 190 C
VESTAVIA AL
35243-5711
US

V. Phone/Fax

Practice location:
  • Phone: 205-271-2584
  • Fax: 205-259-1626
Mailing address:
  • Phone: 205-271-2584
  • Fax: 120-525-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1661
License Number StateAL

VIII. Authorized Official

Name: MRS. JANET E. JACKSON
Title or Position: S-LPC
Credential: M.ED
Phone: 205-271-2584