MEDICARE: CLAIRE ZIMMERMAN JACKSON MA, 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	4316	OK

General Provider Information

NPI Number	:	1376926089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE ZIMMERMAN JACKSON MA, CCC-SLP

Provider Business Mailing Address
First Line	:	4616 CAVEAT DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-7908
Country	:	US
Telephone Number	:	225-975-4985
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 SAINT ANN DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6400
Country	:	US
Telephone Number	:	405-728-7888
Fax Number	:

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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