Provider Demographics
NPI:1285256685
Name:JACKSON, ROCHELLE (RT R CT ARRT)
Entity type:Individual
Prefix:MISS
First Name:ROCHELLE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RT R CT ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 RANCH ROAD 620 N APT 5414
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2847
Mailing Address - Country:US
Mailing Address - Phone:773-430-6523
Mailing Address - Fax:
Practice Address - Street 1:2208 RANCH ROAD 620 N APT 5414
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2847
Practice Address - Country:US
Practice Address - Phone:773-430-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography