Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
MR. JERROLD J JACKSON
Active
Individual
MR. JERROLD J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
107746
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40-4702665
—
MI
01
—
46-31868
UNITED HEALTHCARE INSURANCE
MI
Enumeration date
03/03/2009
Last updated
07/23/2018
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