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1164846101
EMILY JACKSON
PORTLAND, ME
NPI
1164846101
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
235Z00000X Speech-Language Pathologist,
(Licence: ME SP2319)
Enumeration Date
2014-02-11
Last Update Date
2014-10-29
Business Address
Mrs. EMILY JACKSON M.S. CCC-SLP
1600 FOREST AVE
PORTLAND, ME 04103-1314
Phone number: 207-874-8271
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Mailing Address
Mrs. EMILY JACKSON M.S. CCC-SLP
519 PREBLE ST
SOUTH PORTLAND, ME 04106-5018
Phone number: 207-712-4398
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