Krista Sofia Jackson, M.S

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242006552 Issued in IL

Practice address

410 Franklin St
Waukegan, IL 60085-4099

Phone

(224) 303-2160

NPI assigned

Aug 8, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Krista Sofia Billingy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1053085597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 FRANKLIN ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600854099",
            "telephone_number": "224-303-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 FRANKLIN ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600854099",
            "telephone_number": "224-303-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTA",
        "middle_name": "SOFIA",
        "credential": "M.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-08",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242006552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "BILLINGY",
            "middle_name": "SOFIA",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Zaria Ivy
• Rachel Izegbu, BS PH
• Jack Chulengarian DPM PC
• Amanda Jackson, PHARMD
• Briana Jackson, BA
• Matronlybrenda Belinda L Jackson
• Megan Jackson
• William P Jackson, MSW, LCSW, ACSW
• Joann Jacobs, LPC
• Bernice Jacobson, LCSW

• Speech-Language Pathologist in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.