Evian Michelle Jackson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

8233 Issued in LA

Practice address

4055 Prescott Rd
Baton Rouge, LA 70805-5146

Phone

(225) 372-2037

NPI assigned

Sep 11, 2018

Last updated

Aug 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Ms. Evian Michelle Goode Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Democracy Prep Louisiana Charter

  • Local Education Agency (LEA)
  • Baton Rouge, LA
  • NPI 1386203776
  NPD (past)

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1932682358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9655 JUDI AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708154923",
            "telephone_number": "225-938-4445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 PRESCOTT RD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708055146",
            "telephone_number": "225-372-2037"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36505 Oak Plz Ste B",
            "address_purpose": "LOCATION",
            "city": "Prairieville",
            "state": "LA",
            "postal_code": "707693198",
            "country_code": "US",
            "telephone_number": "225-402-4466",
            "fax_number": "225-402-4467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EVIAN",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "8233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010354707",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EVIAN",
            "last_name": "GOODE",
            "middle_name": "MICHELLE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ebony Jackson
• Ed Dacious Jackson
• Elizabeth Eileen Jackson, M.A., CCC-SLP
• Emily C Jackson
• Eneisha Jackson
• Fabian Jackson
• Fannie Jackson
• Fredericka Jackson
• Gerard Jackson, OWNER
• Gerelle G Jackson

• Speech-Language Pathologist in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.