Provider Demographics
NPI:1689984858
Name:JACKSON, ERIN ALANE (EDUCATOR/ELS)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ALANE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:EDUCATOR/ELS
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:ALANE
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 CUSTER ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-490-9055
Mailing Address - Fax:972-265-0392
Practice Address - Street 1:320 CUSTER ROAD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-490-9055
Practice Address - Fax:972-265-0392
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist