MEDICARE: D'NIKA JACKSON

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

General Provider Information

NPI Number	:	1902467202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D'NIKA JACKSON

Provider Business Mailing Address
First Line	:	305 HERITAGE DR
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-4029
Country	:	US
Telephone Number	:	682-667-0852
Fax Number	:	682-667-0852

Provider Business Practice Location Address
First Line	:	1640 ALTAMESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3325
Country	:	US
Telephone Number	:	817-885-4800
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/06/2024

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Directions to “ D'NIKA JACKSON ” Practice Location

Language	Start Address	Practice Location

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