Provider Demographics
NPI:1740348655
Name:JACKSON, CLAUDE NATHANIEL IV (SLP)
Entity type:Individual
Prefix:MR
First Name:CLAUDE
Middle Name:NATHANIEL
Last Name:JACKSON
Suffix:IV
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5943 SAGAMORE BAY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7203
Mailing Address - Country:US
Mailing Address - Phone:832-656-7775
Mailing Address - Fax:832-550-2400
Practice Address - Street 1:5943 SAGAMORE BAY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7203
Practice Address - Country:US
Practice Address - Phone:832-656-7775
Practice Address - Fax:832-550-2400
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist