Provider Demographics
NPI:1831976406
Name:JACKSON, TAYAUNNA MAREE
Entity type:Individual
Prefix:
First Name:TAYAUNNA
Middle Name:MAREE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SUDBROOK LN STE A
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4184
Mailing Address - Country:US
Mailing Address - Phone:443-918-5575
Mailing Address - Fax:877-300-9836
Practice Address - Street 1:115 SUDBROOK LN STE A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4184
Practice Address - Country:US
Practice Address - Phone:443-918-5575
Practice Address - Fax:877-300-9836
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant