Provider Demographics
NPI:1750178414
Name:JACKSON, JENA JADE (SLP)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:JADE
Last Name:JACKSON
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2932
Mailing Address - Country:US
Mailing Address - Phone:216-970-0027
Mailing Address - Fax:
Practice Address - Street 1:9001 W 130TH ST
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1011
Practice Address - Country:US
Practice Address - Phone:440-237-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist