Laura M Jackson, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202008528 Issued in VA

Practice address

7090 Covenant Woods Dr
Mechanicsville, VA 23111-7025

Phone

(804) 569-8000

NPI assigned

Jun 7, 2018

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

Enrolled in GA, SC2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Fox Rehabilitation Services of South Carolina, LLC

  • Physical Therapist
  • Lexington, SC
  • NPI 1902133689

  Speech-Language Pathologist

  Medicare reassignment NPD
• Legacy Healthcare Services, Inc.

  • Physical Therapist
  • Dawsonville, GA
  • NPI 1528419751

  Speech-Language Pathologist

  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Speech-Language Pathologist

  NPD

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1457844110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8202 BEAGLE DR",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232283036",
            "telephone_number": "423-718-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7090 COVENANT WOODS DR",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231117025",
            "telephone_number": "804-569-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAURA",
        "middle_name": "M",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-07",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202008528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isaiah Peace LLC
• Benjamin Isom
• Thais Issa-Weedon
• Theresa Izzo, P.T.
• Kaydreyanna Jackson
• Rebecca Jackson, LPT
• Shanta Dayjah Jackson, RDN
• Verneeky Carenda Jackson, PERSONAL CARE AIDE
• Patricia Jacob, P.T.
• Saeed Jadali, M.D.

• Speech-Language Pathologist in Mechanicsville, VA
• Providers in Mechanicsville, 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 May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.