Provider Demographics
NPI:1568348811
Name:JACKSON, CURTISHA ANGELLIA
Entity type:Individual
Prefix:
First Name:CURTISHA
Middle Name:ANGELLIA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PILGRIMS WAY
Mailing Address - Street 2:
Mailing Address - City:GAYLORDSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06755-1006
Mailing Address - Country:US
Mailing Address - Phone:914-715-0798
Mailing Address - Fax:
Practice Address - Street 1:3536 BREHMS LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1853
Practice Address - Country:US
Practice Address - Phone:410-396-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist