Active NPI
Maria Elena Jackson, M.S., CCC-SLP
- Speech-Language Pathologist
- Atwater, CA
National Provider Identifier
1558849075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 25334
- Practice address
- 970 Travertine Way
Atwater, CA 95301-4486 - Phone
- (209) 614-6731
- NPI assigned
- Aug 6, 2018
- 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 | 25334 | CA | Primary |
Addresses
Primary practice location
970 Travertine Way
Atwater, CA 95301-4486
Mailing address
257 E Bellevue Rd Ste 274
Atwater, CA 95301-2304
Phone (209) 614-6731
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25334 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711497600000",
"number": "1558849075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "257 E BELLEVUE RD STE 274",
"city": "ATWATER",
"state": "CA",
"postal_code": "953012304",
"telephone_number": "209-614-6731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "970 TRAVERTINE WAY",
"city": "ATWATER",
"state": "CA",
"postal_code": "953014486",
"telephone_number": "209-614-6731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARIA",
"middle_name": "ELENA",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-06",
"last_updated": "2024-03-27",
"certification_date": "2024-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "25334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atwater, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.