Kelly Ann Jackson, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA12118 Issued in FL

Practice address

3490 Thrive Dr
Naples, FL 34105-5082

Phone

(239) 354-7081

NPI assigned

Mar 16, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1720789688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15441 CORTONA WAY",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341200676",
            "telephone_number": "407-716-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3490 THRIVE DR",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341055082",
            "telephone_number": "239-354-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA12118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Center, PA
• Jackson Medical Enterprise
• Angela Noelle Jackson, M.A.
• Howard Leslie Jackson, PT
• Jon Ryan Jackson, M.D.
• Margaret Jackson
• Sharon Christina Jackson, M.D.
• Timothy L Jackson
• Jacob Madigan DPT LLC
• Aaron Matthew Jacobs, MD

• Speech-Language Pathologist in Naples, FL
• Providers in Naples, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.