Provider Demographics
NPI:1457041071
Name:JACKSON, KAYLEE O'DELL (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KAYLEE
Middle Name:O'DELL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1152 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2961
Mailing Address - Country:US
Mailing Address - Phone:615-708-7692
Mailing Address - Fax:
Practice Address - Street 1:310 CORPORATE DR STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4638
Practice Address - Country:US
Practice Address - Phone:865-693-5622
Practice Address - Fax:865-686-5820
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN7972235Z00000X
TN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist