| NPI | 1619102001 |
|---|---|
| Other Name | STEPHANIE LYNN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: KY 139606) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.009718) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2017-04-28 |