Active NPI
J. Michele Jackson, CCC-SLP
- Speech-Language Pathologist
- Camden, AR
National Provider Identifier
1205048824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 706
- Practice address
- 2235 California Ave SW
Camden, AR 71701-5605 - Phone
- (870) 836-2654
- NPI assigned
- May 4, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 706 | AR | Primary |
Addresses
Primary practice location
2235 California Ave SW
Camden, AR 71701-5605
Mailing address
288 Choctaw RDG
El Dorado, AR 71730-2250
Phone (870) 918-2894
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 706 | AR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413504000000",
"number": "1205048824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "288 CHOCTAW RDG",
"city": "EL DORADO",
"state": "AR",
"postal_code": "717302250",
"telephone_number": "870-918-2894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2235 CALIFORNIA AVE SW",
"city": "CAMDEN",
"state": "AR",
"postal_code": "717015605",
"telephone_number": "870-836-2654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "J.",
"middle_name": "MICHELE",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2014-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camden, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.