Laurie Jackson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL011613 Issued in PA

Practice address

122 Ashley Hill Dr
Wexford, PA 15090-9457

Phone

(703) 955-0716

NPI assigned

Jun 8, 2018

Last updated

Jun 8, 2018By the provider in NPPES

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

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": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1467945089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 ASHLEY HILL DR",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150909457",
            "telephone_number": "703-955-0716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 ASHLEY HILL DR",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150909457",
            "telephone_number": "703-955-0716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAURIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-08",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL011613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valentyna Ivanova, MD
• Madeline Seanor Ivory, WHNP-BC
• Jill Yvonne Jacaszek, MA CCC SLP
• Elsbeth Davis Jacks, MS, PT, PCS
• Kristen Jackson, PA-C
• Maddilyn Jackson
• Maryrose Jackson
• Sienna Kier Jackson
• Erica Lynn Jacobs
• Jami Jahn, RPH

• Speech-Language Pathologist in Wexford, PA
• Providers in Wexford, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.

Verify at the official NPI Registry.