Provider Demographics
NPI:1164976486
Name:JACKSON, LATOYA MOSELY (MS)
Entity type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:MOSELY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LATOYA
Other - Middle Name:DEANNA
Other - Last Name:MOSELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16102 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6129
Mailing Address - Country:US
Mailing Address - Phone:813-873-1936
Mailing Address - Fax:813-873-8837
Practice Address - Street 1:16102 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6129
Practice Address - Country:US
Practice Address - Phone:813-873-1936
Practice Address - Fax:813-873-8837
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist