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 |