Provider Demographics
NPI:1881825883
Name:JACKS, ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:JACKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 FARRINGTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8154
Mailing Address - Country:US
Mailing Address - Phone:919-966-5975
Mailing Address - Fax:919-966-8384
Practice Address - Street 1:6015 FARRINGTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8154
Practice Address - Country:US
Practice Address - Phone:919-966-5975
Practice Address - Fax:919-966-8384
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist