Provider Demographics
NPI:1760146708
Name:JACKSON, AMY Z (AUD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:Z
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27310 OAK RIDGE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9042
Mailing Address - Country:US
Mailing Address - Phone:936-709-8204
Mailing Address - Fax:936-709-7557
Practice Address - Street 1:27310 OAK RIDGE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-9042
Practice Address - Country:US
Practice Address - Phone:936-709-8204
Practice Address - Fax:936-709-7557
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51377231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist