Doctor Name: | COURTNEY JACKS |
NPI Number: | 1043446628 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 7723 |
Business Practice Address: | 9 Hope Ave Waltham, MA - 024532741 |
Business Phone Number: | 7812162234 |
Business Fax Number: | 7812162252 |
Mailing Address: | 9 Hope Ave, WALTHAM |
State: | MA |
Postal Code: | 024532741 |
Phone Number: | 7812162234 |
Fax Number: | 7812162252 |
NPI Enumeration Date: | 06/09/2009 |
NPI Last Update Date: | 05/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7723 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |