Provider Demographics
NPI:1558554055
Name:JACKSON, CARLA WOOD (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:WOOD
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 1:600 W COLLEGE AVE
Mailing Address - Street 2:FSU SPEECH & HEARING CLINIC
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-1058
Mailing Address - Country:US
Mailing Address - Phone:850-645-6567
Mailing Address - Fax:850-644-8994
Practice Address - Street 1:600 W COLLEGE AVE
Practice Address - Street 2:FSU SPEECH & HEARING CLINIC
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-1058
Practice Address - Country:US
Practice Address - Phone:850-645-6567
Practice Address - Fax:850-644-8994
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist