Individual
JACKIE ELAINE BEATTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
750 LAKESHORE DR., PIERSON, FL 32180
(321) 231-2962
(888) 845-9818
Mailing address
750 LAKESHORE DR., PIERSON, FL 32180
(321) 231-2962
(888) 845-9818
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
SA8761
FL
235Z00000X
Speech-Language Pathologist
Primary
SA8761
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000476900
—
FL
05
—
890711100
—
FL
Enumeration date
07/12/2006
Last updated
01/19/2026
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