Basic Information
| Provider Information | |||||||||
| NPI: | 1689828170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | SHERRY | ||||||||
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| Credential: | MS/CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2321 BERKSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152412403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128519658 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1780 KENDARBREN DR | ||||||||
| Address2: | |||||||||
| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189291064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2008 | ||||||||
| LastUpdateDate: | 11/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 003562 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.