Jerry Elliott Wilcoxon, MACCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA 10677 Issued in FL

Practice address

4048 Grande Blvd
Jacksonville, FL 32250-3021

Phone

(904) 566-6031

NPI assigned

Oct 29, 2012

Last updated

Nov 9, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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": "1351468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1366796476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4048 GRANDE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322503021",
            "telephone_number": "904-566-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4048 GRANDE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322503021",
            "telephone_number": "904-566-6031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCOXON",
        "first_name": "JERRY",
        "middle_name": "ELLIOTT",
        "name_prefix": "Mr.",
        "credential": "MACCCSLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-29",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA 10677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chandler Curtis Wilcox, MD
• Jennell Wilcox, COTA
• Kenyannya Wilcox
• Tracy Nicole Wilcox, PTA, LAT, ATC
• Victoria Garten Wilcox, LMHC
• Vanessa Jaclyn Wilczak, D.C.
• Steven Edward Wildasin, CRNA
• Nicholas Emil Wilde, MD
• Rebekah Leah Wildenberg
• Alyson Gibson Wilder, PHARMD, BCPS

• Speech-Language Pathologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; 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.