Provider Demographics
NPI:1710796487
Name:JACKSON, CHRISTINE NICOLE (MS, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 DURAND DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3234
Mailing Address - Country:US
Mailing Address - Phone:531-772-6516
Mailing Address - Fax:
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:531-355-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist