| NPI | 1083892665 |
|---|---|
| Former Name | WENDY K JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60638000) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 363AM0700X Physician Assistant, Medical (Licence: OR PA164630) | |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2020-10-14 |