Kendall Jackson, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP008103 Issued in GA

Practice address

3485 N Desert Dr Ste 105
East Point, GA 30344-5724

Phone

(678) 724-7033

Fax

(678) 302-7357

NPI assigned

Jul 6, 2012

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Bright Future Therapy Services

  • Hearing and Speech Clinic/Center
  • East Point, GA
  • NPI 1346046349
  NPD Authorized official

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1477818342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3460 SOMERSET TRL SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303317935",
            "telephone_number": "864-323-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3485 N DESERT DR STE 105",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303445724",
            "telephone_number": "678-724-7033",
            "fax_number": "678-302-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KENDALL",
        "name_prefix": "Ms.",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-06",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP008103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126519G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gwendolyn Izell, M.A., CCC-SLP
• J. D Murray DDS & Associates P.C
• Phyllis Jackson-Smith, LCSW
• Charmeka Jackson
• Danielle Nicole Jackson, O.D.
• Stephen Jackson, M.D.
• Tiffany Jackson, LMSW
• James K. Fortson, M.D., P.C.
• James M Freemont Sr MD Mha PC
• James M. Freemont, MD, PC

• Speech-Language Pathologist in East Point, GA
• Providers in East Point, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; 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.