MEDICARE: KIMBERLY A JACKMAN 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	SA 4259	FL
2	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA 4259	OTHER	FL	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447346929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A JACKMAN MA CCC-SLP

Provider Business Mailing Address
First Line	:	4296 SEA ROCK COURT
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-4832
Country	:	US
Telephone Number	:	407-222-0046
Fax Number	:	270-818-1558

Provider Business Practice Location Address
First Line	:	4296 SEA ROCK COURT
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-4832
Country	:	US
Telephone Number	:	407-222-0046
Fax Number	:	270-818-1558

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY A JACKMAN MA CCC-SLP” Practice Location

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