Provider Demographics
NPI:1639305014
Name:JACKSON JADE & ASSOCIATES, A SPEECH PATHOLOGY CORPORATION
Entity Type:Organization
Organization Name:JACKSON JADE & ASSOCIATES, A SPEECH PATHOLOGY CORPORATION
Other - Org Name:JACKSON JADE SPEECH, OCCUPATIONAL & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:888-808-7838
Mailing Address - Street 1:249 E OCEAN BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4806
Mailing Address - Country:US
Mailing Address - Phone:888-808-7838
Mailing Address - Fax:866-620-3943
Practice Address - Street 1:249 E OCEAN BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4806
Practice Address - Country:US
Practice Address - Phone:888-808-7838
Practice Address - Fax:866-620-3943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-30
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty