Provider Demographics
NPI:1821513664
Name:JACKSON, KOREN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KOREN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:KOREN
Other - Middle Name:
Other - Last Name:BEARDSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:7 HIGHMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1423
Mailing Address - Country:US
Mailing Address - Phone:412-600-9267
Mailing Address - Fax:
Practice Address - Street 1:7 HIGHMEADOW RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-1423
Practice Address - Country:US
Practice Address - Phone:412-600-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA013220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist