MEDICARE: MRS. VICTORIA LYNN JACKSON M.N.S., CCC-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	102585	TX

General Provider Information

NPI Number	:	1194901934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA LYNN JACKSON M.N.S., CCC-SLP

Provider Business Mailing Address
First Line	:	7315 ROARING SPRINGS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-3319
Country	:	US
Telephone Number	:	512-539-7286
Fax Number	:

Provider Business Practice Location Address
First Line	:	7315 ROARING SPRINGS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-3319
Country	:	US
Telephone Number	:	512-539-7286
Fax Number	:

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

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/20/2014

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