Active NPI
Jerrold J Jackson, SLP
- Speech-Language Pathologist
- Irving, TX
National Provider Identifier
1457591455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 107746
- Practice address
- 1231 Greenway Dr Ste 100
Irving, TX 75038 - Phone
- (972) 871-1800
- NPI assigned
- Mar 3, 2009
- Sex
- Male
- 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 | 107746 | TX | Primary |
Addresses
Primary practice location
1231 Greenway Dr Ste 100
Irving, TX 75038
Mailing address
728 Bray St
Cedar Hill, TX 75104-6058
Phone (972) 802-1176
Other practice location 1
1000 Oakland Dr Fl 3
Kalamazoo, MI 49008-1282
Phone (269) 387-7004
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46-31868 | Other | MI | UNITED HEALTHCARE INSURANCE |
| 40-4702665 | Medicaid | MI |
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 |
|---|---|---|---|
| 107746 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FST, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Irving, TX
- NPI 1952602476
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532304000000",
"number": "1457591455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "728 BRAY ST",
"city": "CEDAR HILL",
"state": "TX",
"postal_code": "751046058",
"telephone_number": "972-802-1176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1231 GREENWAY DR STE 100",
"city": "IRVING",
"state": "TX",
"postal_code": "75038",
"telephone_number": "972-871-1800"
}
],
"practiceLocations": [
{
"address_1": "1000 Oakland Dr Fl 3",
"address_purpose": "LOCATION",
"city": "Kalamazoo",
"state": "MI",
"postal_code": "490081282",
"country_code": "US",
"telephone_number": "269-387-7004",
"fax_number": "269-387-7026",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "JERROLD",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-03",
"last_updated": "2018-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "107746",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE INSURANCE",
"identifier": "46-31868",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40-4702665",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.