Active NPI
Amelia Jackson, M.S., SLP-CCC
- Speech-Language Pathologist
- Draper, UT
National Provider Identifier
1407664402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12333349-4102
- Practice address
- 138 E 12300 S Unit 933
Draper, UT 84020-7976 - Phone
- (385) 352-3983
- NPI assigned
- Dec 21, 2024
- 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 | 12333349-4102 | UT | Primary |
Addresses
Primary practice location
138 E 12300 S Unit 933
Draper, UT 84020-7976
Mailing address
138 E 12300 S Unit 933
Draper, UT 84020-7976
Phone (385) 352-3983
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12333349-4102 | UT | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785888000000",
"number": "1407664402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 E 12300 S UNIT 933",
"city": "DRAPER",
"state": "UT",
"postal_code": "840207976",
"telephone_number": "385-352-3983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 E 12300 S UNIT 933",
"city": "DRAPER",
"state": "UT",
"postal_code": "840207976",
"telephone_number": "385-352-3983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "AMELIA",
"credential": "M.S., SLP-CCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-21",
"last_updated": "2026-08-05",
"certification_date": "2026-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "UT",
"license": "12333349-4102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.