Provider Demographics
NPI:1255169868
Name:JACKSON, RHONDA L (SLP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:JACKSON
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 1:7406 GLEN MANOR DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-1720
Mailing Address - Country:US
Mailing Address - Phone:713-428-8119
Mailing Address - Fax:
Practice Address - Street 1:23435 FM 1314 RD STE C6
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-7738
Practice Address - Country:US
Practice Address - Phone:281-354-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist