Provider Demographics
NPI:1942948757
Name:JACKSON-KELLEY, LATONYA (SLP)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:JACKSON-KELLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 SAGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7131
Mailing Address - Country:US
Mailing Address - Phone:281-235-0927
Mailing Address - Fax:
Practice Address - Street 1:1515 CHERRYBROOK LN
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-4099
Practice Address - Country:US
Practice Address - Phone:713-740-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist