Provider Demographics
NPI:1326527383
Name:JACKSON, ALEXANDRIA BLAIR (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:BLAIR
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:ALEXANDRIA
Other - Middle Name:BLAIR
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 N TEXAS AVE STE 3100
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4966
Mailing Address - Country:US
Mailing Address - Phone:281-338-7135
Mailing Address - Fax:281-525-4183
Practice Address - Street 1:333 N TEXAS AVE STE 3100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4966
Practice Address - Country:US
Practice Address - Phone:281-338-7135
Practice Address - Fax:281-525-4183
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81098231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist