Provider Demographics
NPI:1003504895
Name:JACKSON, JANAI CASSANDRA
Entity Type:Individual
Prefix:MS
First Name:JANAI
Middle Name:CASSANDRA
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 1:721 BOULDER SPRINGS DR APT B2
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5533
Mailing Address - Country:US
Mailing Address - Phone:804-937-1993
Mailing Address - Fax:
Practice Address - Street 1:1901 CHARLES ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3504
Practice Address - Country:US
Practice Address - Phone:804-673-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist