Active NPI
Tonya Elaine Jackson, SLP
- Speech-Language Pathologist
- Charlotte, NC
National Provider Identifier
1982065710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7555
- Practice address
- 11204 Chastain Parc Dr
Charlotte, NC 28216-7662 - Phone
- (704) 804-8577
- Fax
- (980) 207-2380
- NPI assigned
- Mar 7, 2016
- 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 | 7555 | NC | Primary |
Addresses
Primary practice location
11204 Chastain Parc Dr
Charlotte, NC 28216-7662
Mailing address
11204 Chastain Parc Dr
Charlotte, NC 28216-7662
Phone (704) 804-8577
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7555 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457308800000",
"number": "1982065710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11204 CHASTAIN PARC DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282167662",
"telephone_number": "704-804-8577",
"fax_number": "980-207-2380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11204 CHASTAIN PARC DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282167662",
"telephone_number": "704-804-8577",
"fax_number": "980-207-2380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TONYA",
"middle_name": "ELAINE",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-07",
"last_updated": "2016-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "7555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.