| Doctor Name: | MRS. TAMARA M JACKSON |
| NPI Number: | 1366882714 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SZ5869 |
| Business Practice Address: | 53 Ash Dr Hollywood, FL - 330261102 |
| Business Phone Number: | 9545796131 |
| Business Fax Number: | |
| Mailing Address: | 1240 Sw 171st Ter, PEMBROKE PINES |
| State: | FL |
| Postal Code: | 330271435 |
| Phone Number: | 9548127255 |
| Fax Number: | |
| NPI Enumeration Date: | 06/30/2013 |
| NPI Last Update Date: | 06/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SZ5869 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |