Provider Demographics
NPI:1841939477
Name:JACKSON, LAUREN P (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:P
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 PERIDOT
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-6144
Mailing Address - Country:US
Mailing Address - Phone:409-291-1460
Mailing Address - Fax:
Practice Address - Street 1:9021 PERIDOT
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-6144
Practice Address - Country:US
Practice Address - Phone:409-291-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist