Active NPI
Bettina Monet Jackson, MS CCC-SLP
- Speech-Language Pathologist
- Upper Marlboro, MD
National Provider Identifier
1497739395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 03049
- Practice address
- 10312 Grandhaven Ave
Upper Marlboro, MD 20772-6602 - Phone
- (202) 352-5699
- NPI assigned
- Dec 4, 2005
- 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 Pathologist | 235Z00000X | 03049 | MD | Primary |
Addresses
Primary practice location
10312 Grandhaven Ave
Upper Marlboro, MD 20772-6602
Mailing address
10312 Grandhaven Ave
Upper Marlboro, MD 20772-6602
Phone (202) 352-5699
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03049 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375747200000",
"number": "1497739395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10312 GRANDHAVEN AVE",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207726602",
"telephone_number": "202-352-5699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10312 GRANDHAVEN AVE",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207726602",
"telephone_number": "202-352-5699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BETTINA",
"middle_name": "MONET",
"name_prefix": "Ms.",
"credential": "MS CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-04",
"last_updated": "2013-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "03049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.