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General NPI Number Information
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NPI Number | 1114867819
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Entity Type | Individual
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Provider Name | ALEXANDRA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 905 ASSISI LN
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City | JACKSONVILLE
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State | FL
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Zip | 32233-2972
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Country | US
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Telephone | 904-449-7124
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 BARTOLOME RD
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-1632
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Country | US
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Telephone | 859-409-2033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA16371
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License Number State | FL
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