Active NPI
Courtney Jackson, SLP ASSISTANT
- Speech-Language Assistant
- Edinburg, TX
National Provider Identifier
1487930723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 34883
- Practice address
- 19424 Fallow LN
Edinburg, TX 78542-1038 - Phone
- (956) 457-2645
- NPI assigned
- Nov 1, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 Assistant | 2355S0801X | 34883 | TX | Primary |
Addresses
Primary practice location
19424 Fallow LN
Edinburg, TX 78542-1038
Mailing address
19424 Fallow LN
Edinburg, TX 78542-1038
Phone (956) 457-2645
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 |
|---|---|---|---|
| 34883 | TX | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320105600000",
"number": "1487930723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19424 FALLOW LN",
"city": "EDINBURG",
"state": "TX",
"postal_code": "785421038",
"telephone_number": "956-457-2645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19424 FALLOW LN",
"city": "EDINBURG",
"state": "TX",
"postal_code": "785421038",
"telephone_number": "956-457-2645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "COURTNEY",
"credential": "SLP ASSISTANT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-01",
"last_updated": "2011-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "TX",
"license": "34883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edinburg, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.