Provider Demographics
NPI:1922236876
Name:JACKSON, CHRISTINA ELIZABETH (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6240 HACKBERRY CREEK TRL
Mailing Address - Street 2:APT. # 324
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0468
Mailing Address - Country:US
Mailing Address - Phone:704-299-6319
Mailing Address - Fax:
Practice Address - Street 1:6240 HACKBERRY CREEK TRL
Practice Address - Street 2:APT. # 324
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0468
Practice Address - Country:US
Practice Address - Phone:704-299-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist