Irene Shetzline Jackson, M.A. CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202004915 Issued in VA

Practice address

1006 S Columbus St
Arlington, VA 22204-3424

Phone

(703) 772-2449

NPI assigned

Mar 5, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236211200000",
    "number": "1417197344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 S COLUMBUS ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222043424",
            "telephone_number": "703-772-2449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 S COLUMBUS ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222043424",
            "telephone_number": "703-772-2449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "IRENE",
        "middle_name": "SHETZLINE",
        "credential": "M.A. CCCSLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-05",
        "last_updated": "2009-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202004915",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "4622",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jac Counseling PLLC
• Jenna Jach
• Araba Amonu Jackson, M.D.
• Charles Bradford Jackson, MD
• Faunice Rebecca Jackson, DPT, P.T.
• Kaitlyn Jackson, DNAP, CRNA
• Takiya Nachelle Jackson, M.ED
• Terrina Jackson
• Annamma J Jacob, M.D.
• Katherine Sessoms Jacobi, LCSW

• Speech-Language Pathologist in Arlington, VA
• Providers in Arlington, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; 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.