Active NPI
Mandy Jackson
- Speech-Language Pathologist
- Summerville, SC
National Provider Identifier
1093365165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7056
- Practice address
- 108 Proprietors CT
Summerville, SC 29485-3467 - Phone
- (843) 900-7761
- NPI assigned
- Sep 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7056 | SC | Primary |
Addresses
Primary practice location
108 Proprietors CT
Summerville, SC 29485-3467
Mailing address
108 Proprietors CT
Summerville, SC 29485-3467
Phone (843) 900-7761
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | mandy@lowcountryspeechservices.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7056 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568851200000",
"number": "1093365165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 PROPRIETORS CT",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294853467",
"telephone_number": "843-900-7761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 PROPRIETORS CT",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294853467",
"telephone_number": "843-900-7761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MANDY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-19",
"last_updated": "2019-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "SC",
"license": "7056",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "mandy@lowcountryspeechservices.com",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "108 Proprietors Ct",
"city": "Summerville",
"state": "SC",
"country_code": "US",
"postal_code": "294853467",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.