Healthcare Provider Details

I. General information

NPI: 1942089479
Provider Name (Legal Business Name): ASHLEY NICOLE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10946 RED OAK DR
BATON ROUGE LA
70815-1933
US

IV. Provider business mailing address

10946 RED OAK DR
BATON ROUGE LA
70815-1933
US

V. Phone/Fax

Practice location:
  • Phone: 225-288-0071
  • Fax: 866-500-2186
Mailing address:
  • Phone: 225-288-0071
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9624
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: