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MRS. KELLY GREEN JACKSON S.L.P.
NPI 1083632467
Speech-Language Pathologist in Lake Park, GA

Active since July 17, 2006
5314 MOSS OAK TRL, LAKE PARK, GA 31636(386) 362-8564 Get Directions Write a Review

NPPES record last updated: January 27, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mrs. Kelly Green Jackson S.l.p. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KELLY GREEN JACKSON S.L.P. (NPI 1083632467) is an individual speech-language pathologist provider in Lake Park, Georgia, licensed in Florida (SA8681) and active in the NPI registry since July 2006.

NPPES Registry Identity

NPI1083632467
Entity TypeIndividualFemale
Primary Taxonomy235Z00000X
Provider Legal NameMRS. KELLY GREEN JACKSONCredential: S.L.P.
Location Address5314 MOSS OAK TRLLake Park, GA 31636-3300
Mailing Address5314 Moss Oak TrlLake Park, GA 31636-3300 · (386) 362-8564
Phone(386) 362-8564
Sole ProprietorYes
Enumeration DateJuly 17, 2006
Last NPPES UpdateJanuary 27, 2025
NPPES CertifiedJanuary 27, 2025
✔ NPI 1083632467 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers
Taxonomy Code235Z00000X
License✔ Licensed in FL · SA8681
Definition
The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.
5314 MOSS OAK TRL, Lake Park, GA 31636
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Jackson's NPI number?

The NPI number for Kelly Jackson is 1083632467. It was assigned to this individual provider in the NPPES registry on July 17, 2006.

Where is Kelly Jackson located?

Kelly Jackson practices at 5314 Moss Oak Trl, Lake Park, GA 31636. The listed phone number is (386) 362-8564.

What is Kelly Jackson's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

When was this NPI record last updated?

The NPPES record for Kelly Jackson was last updated on January 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.