| Doctor Name: | MARY JANE JACK |
| NPI Number: | 1144312265 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSP CCC-SLP |
| License Number: | ASHA 01088409 |
| Business Practice Address: | 1101 Health Professions Building Mt Pleasant, MI - 488590001 |
| Business Phone Number: | 9897747290 |
| Business Fax Number: | 9897741891 |
| Mailing Address: | 1101 Health Professions Building, MT PLEASANT |
| State: | MI |
| Postal Code: | 488590001 |
| Phone Number: | 9897747290 |
| Fax Number: | 9897741891 |
| NPI Enumeration Date: | 09/28/2006 |
| NPI Last Update Date: | 03/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | ASHA 01088409 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| 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 |