Active NPI
Kandice Jackson
- Speech-Language Pathologist
- Dallas, TX
National Provider Identifier
1528333143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 114858
- Practice address
- 6301 Gaston Ave Ste 750
Dallas, TX 75214-3922 - Phone
- (214) 295-5374
- NPI assigned
- Mar 15, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7315 | CA | |
| Speech-Language Pathologist | 235Z00000X | 114858 | TX | Primary |
Addresses
Primary practice location
6301 Gaston Ave Ste 750
Dallas, TX 75214-3922
Mailing address
1071 Lake Carolyn Pkwy Apt 4082
Irving, TX 75039-4874
Phone (949) 702-4195
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 |
|---|---|---|---|
| 114858 | TX | MD | Occupational Therapist |
| 7315 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548201600000",
"number": "1528333143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1071 LAKE CAROLYN PKWY APT 4082",
"city": "IRVING",
"state": "TX",
"postal_code": "750394874",
"telephone_number": "949-702-4195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6301 GASTON AVE STE 750",
"city": "DALLAS",
"state": "TX",
"postal_code": "752143922",
"telephone_number": "214-295-5374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KANDICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-15",
"last_updated": "2019-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "7315",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "114858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.