MEDICARE: MARGARET JACKSON 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
1	235Z00000X	Speech-Language Pathologist	555	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114066057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET JACKSON SLP

Provider Business Mailing Address
First Line	:	2300 ARENAL RD SW
Second Line	:	RIO GRANDE HS
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4160
Country	:	US
Telephone Number	:	505-873-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 ARENAL RD SW
Second Line	:	RIO GRANDE HS
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4160
Country	:	US
Telephone Number	:	505-873-0220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/09/2007

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