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NPI Code Detail

MEDICARE: LAURA G JACKSON MS CCC-SLP

MEDICARE: LAURA G JACKSON MS 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
1235Z00000XSpeech-Language Pathologist21255CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10OTHERTHERAPIST

General Provider Information

NPI Number : 1831497189
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA G JACKSON MS CCC-SLP
Provider Business Mailing Address
First Line : 637 E ROMIE LN
Second Line :
City : SALINAS
State : CA
Zip : 93901-4205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 637 E ROMIE LN
Second Line :
City : SALINAS
State : CA
Zip : 93901-4205
Country : US
Telephone Number : 831-424-0687
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2011
Last Update Date : 07/17/2014

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Directions to “ LAURA G JACKSON MS CCC-SLP” Practice Location

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