Mary Elizabeth Jackson, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

TSLP12908 Issued in AZ

Practice address

3857 E Decatur St
Mesa, AZ 85205-6142

Phone

(480) 433-4198

NPI assigned

Dec 8, 2014

Last updated

Apr 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mary Elizabeth Spencer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1770981771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 E DECATUR ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852056142",
            "telephone_number": "480-433-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3857 E DECATUR ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852056142",
            "telephone_number": "480-433-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-08",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "AZ",
            "license": "#SLPA9187",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "TSLP12908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SPENCER",
            "middle_name": "ELIZABETH",
            "credential": "SLPA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer R Jackson, LPC
• Jillian Jackson, PA
• Joshua Jackson
• Julie Jackson
• Lee Sa B. Jackson, M.D.
• Matthew Paul Jackson, D.O.
• Michael Darren Jackson, P.A.
• Randy Jackson
• Sam Jackson, LAC
• Tahara Jackson

• Speech-Language Pathologist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.