Provider Demographics
NPI:1235448838
Name:JACKSON, CATHERINE ALICE (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ALICE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALIFORNIA STATE UNIVERSITY NORTHRIDGE
Mailing Address - Street 2:18111 NORDHOFF STREET
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91330-8279
Mailing Address - Country:US
Mailing Address - Phone:818-677-2851
Mailing Address - Fax:
Practice Address - Street 1:CALIFORNIA STATE UNIVERSITY NORTHRIDGE
Practice Address - Street 2:18111 NORDHOFF STREET
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8279
Practice Address - Country:US
Practice Address - Phone:818-677-2851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist