| NPI | 1114376910 |
|---|---|
| Former Name | AMY JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 51603) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 51603) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |