Mary Jane Jack, MSP CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

ASHA 01088409 Issued in MI

Practice address

1101 Health Professions Building
Mt Pleasant, MI 48859-0001

Phone

(989) 774-7290

Fax

(989) 774-1891

NPI assigned

Sep 28, 2006

Last updated

Mar 4, 2010By the provider in NPPES

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 identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267660800000",
    "number": "1144312265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BUILDING",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-7290",
            "fax_number": "989-774-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BUILDING",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-7290",
            "fax_number": "989-774-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "MARY",
        "middle_name": "JANE",
        "credential": "MSP CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2010-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "ASHA 01088409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA NUMBER",
            "identifier": "01088409",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40-4683793",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isabella Health Care Center PLLC
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• John Andrew Iserhoth III, R.PH.
• Isomm LLC (Open MRI Mt Pleasant)
• It's All About Time Transportation LLC (About Time Transportation)
• Richard L Jack, RPH
• Barbara Rae Jackson, AU.D.
• Benjamin Jackson, RPH
• Joy Katherine Jackson
• Patricia Jackson

• Speech-Language Pathologist in Mt Pleasant, MI
• Providers in Mt Pleasant, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; 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.