Provider Demographics
NPI:1104053354
Name:JACKSON, SHAWNA LYNN (AUD)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:LYNN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7298
Mailing Address - Country:US
Mailing Address - Phone:972-883-3010
Mailing Address - Fax:972-883-3022
Practice Address - Street 1:700 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-5552
Practice Address - Country:US
Practice Address - Phone:281-338-0829
Practice Address - Fax:281-557-7284
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020706231H00000X, 237600000X
TX80242237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter