| Doctor Name: | PHYLLIS JACKSON |
| NPI Number: | 1154473684 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | S.T. |
| License Number: | 941 |
| Business Practice Address: | 9384 Florida Boulevard Suite F Walker, LA - 70785 |
| Business Phone Number: | 2257910911 |
| Business Fax Number: | 2257911977 |
| Mailing Address: | 9384 Florida Boulevard, Suite F WALKER |
| State: | LA |
| Postal Code: | 70785 |
| Phone Number: | 2257910911 |
| Fax Number: | 2257911977 |
| NPI Enumeration Date: | 01/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 941 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| 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 |