Active NPI
Lakeisha Jackson
- Speech-Language Pathologist
- Woodstock, GA
National Provider Identifier
1962874099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP006166
- Practice address
- 225 Creekstone RDG Ste 25
Woodstock, GA 30188-3744 - Phone
- (404) 939-5976
- NPI assigned
- Oct 28, 2015
- Sex
- Female
- Sole proprietor
- No
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 | SLP006166 | GA | Primary |
Addresses
Primary practice location
225 Creekstone RDG Ste 25
Woodstock, GA 30188-3744
Mailing address
744 Noah Dr Ste 113-374
Jasper, GA 30143-8705
Phone (404) 939-5976
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003219302A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230405002482 | GA | Practitioner - Qualified Speech Language Pathologist | 4082089024 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698105600000",
"number": "1962874099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "744 NOAH DR STE 113-374",
"city": "JASPER",
"state": "GA",
"postal_code": "301438705",
"telephone_number": "404-939-5976",
"fax_number": "404-920-3496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 CREEKSTONE RDG STE 25",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301883744",
"telephone_number": "404-939-5976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LAKEISHA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-28",
"last_updated": "2023-10-24",
"certification_date": "2023-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP006166",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003219302A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.