MEDICARE: JAIDEN ELIZABETH JEFFERSON

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	2355S0801X	Speech-Language Assistant	44304	TX

General Provider Information

NPI Number	:	1639027543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIDEN ELIZABETH JEFFERSON

Provider Business Mailing Address
First Line	:	9718 ROLLINSON PARK DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5253
Country	:	US
Telephone Number	:	832-539-1632
Fax Number	:	832-539-1633

Provider Business Practice Location Address
First Line	:	9718 ROLLINSON PARK DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5253
Country	:	US
Telephone Number	:	832-539-1632
Fax Number	:	832-539-1633

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ JAIDEN ELIZABETH JEFFERSON ” Practice Location

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