Debra Marlene Jackson, MS-CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146003388 Issued in IL

Practice address

1219 Troy Rd
Edwardsville, IL 62025-2363

Phone

(618) 960-7696

Fax

(130) 921-6271

NPI assigned

May 17, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1245282904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 TROY RD",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252363",
            "telephone_number": "618-960-7696",
            "fax_number": "130-921-6271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 TROY RD",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252363",
            "telephone_number": "618-960-7696",
            "fax_number": "130-921-6271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEBRA",
        "middle_name": "MARLENE",
        "name_prefix": "Ms.",
        "credential": "MS-CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146003388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Edwardsville, IL
• Providers in Edwardsville, 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 Aug 23, 2011; 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.