Provider Demographics
NPI:1821404526
Name:JACKSON, ERIN COLLEEN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:COLLEEN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:COLLEEN
Other - Last Name:ANDERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:166 W CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2526
Mailing Address - Country:US
Mailing Address - Phone:317-570-9205
Mailing Address - Fax:317-575-9206
Practice Address - Street 1:166 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2526
Practice Address - Country:US
Practice Address - Phone:317-570-9205
Practice Address - Fax:317-575-9206
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005938A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist