Provider Demographics
NPI:1447729223
Name:JACKSON, DEONKA SHANEY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEONKA
Middle Name:SHANEY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:DEONKA
Other - Middle Name:SHANEY
Other - Last Name:CEASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1519 28TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-3770
Mailing Address - Country:US
Mailing Address - Phone:832-293-2584
Mailing Address - Fax:
Practice Address - Street 1:1519 28TH ST NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-3770
Practice Address - Country:US
Practice Address - Phone:832-293-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111873235Z00000X
WALL60907224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist