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Individual
MRS. TIFFANY JACKSON
Active
Individual
MRS. TIFFANY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CCC/SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5174
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130AT
BCBS
NC
05
—
7411661
—
NC
Enumeration date
10/25/2007
Last updated
09/30/2009
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