Healthcare Provider Details

I. General information

NPI: 1922422872
Provider Name (Legal Business Name): JAZZMIN JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SAWDUST RD APT 160
SPRING TX
77380-4149
US

IV. Provider business mailing address

780 SAWDUST RD APT 160
SPRING TX
77380-4149
US

V. Phone/Fax

Practice location:
  • Phone: 281-687-2854
  • Fax:
Mailing address:
  • Phone: 281-687-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number37181
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: