SERENA JACKSON — NPI 1730090234 (Licensed & Credentialed Specialist/Technologist, Speech-Language Assistant in BUFFALO, MO)

CMS-1500 Box 24J / 33a • NPI

1730090234

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

2355S0801X

Licensed & Credentialed Specialist/Technologist, Speech-Language Assistant

Box 32 Service Location & ZIP+4

1323 S ASH ST, BUFFALO, MO, 65622-9311

✓ 9-Digit EDI 837 ZIP+4 (65622-9311)

Practice Phone & Referral Fax

(417) 345-2222

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1730090234 (SERENA JACKSON) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1730090234` (NPI-1 Individual Practitioner)
Provider / Legal Name	SERENA JACKSON
Plain-English Specialty	Licensed & Credentialed Specialist/Technologist, Speech-Language Assistant NUCC Code: `2355S0801X` (Specialist/Technologist, Speech-Language Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1323 S ASH ST, BUFFALO, MO, 65622-9311
Practice Telephone / Fax	Tel: (417) 345-2222
Administrative Mailing Address	3811 S WELLER AVE APT B306, SPRINGFIELD, MO, 65804-5364
Enumeration & Last Sync	Enumerated: 2026-09-14 \| CMS Record Updated: 2026-09-14

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1323 S ASH ST, BUFFALO, MO, 65622-9311

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Plain-English Taxonomy & CMS Crosswalk (2355S0801X)

What Does Taxonomy Code 2355S0801X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2355S0801X translates to:
"Licensed & Credentialed Specialist/Technologist, Speech-Language Assistant"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Specialist/Technologist, Speech-Language Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (SERENA JACKSON)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2355S0801X` — Specialist/Technologist, Speech-Language Assistant Plain English: Licensed & Credentialed Specialist/Technologist, Speech-Language Assistant	State: MO \| License: `2026031707` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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SERENA JACKSON (NPI #1730090234)