| Doctor Name: | KANDICE JACKSON |
| NPI Number: | 1528333143 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 7315 |
| Business Practice Address: | 26284 Oso Rd Ste 114 San Juan Capistrano, CA - 926751629 |
| Business Phone Number: | 9498429557 |
| Business Fax Number: | |
| Mailing Address: | 28401 Los Alisos Blvd Apt 6305, MISSION VIEJO |
| State: | CA |
| Postal Code: | 926925956 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/15/2012 |
| NPI Last Update Date: | 03/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7315 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |