Doctor Name: | MRS. EMILY JACKSON |
NPI Number: | 1164846101 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | SP2319 |
Business Practice Address: | 1600 Forest Ave Portland, ME - 041031314 |
Business Phone Number: | 2078748271 |
Business Fax Number: | |
Mailing Address: | 519 Preble St, SOUTH PORTLAND |
State: | ME |
Postal Code: | 041065018 |
Phone Number: | 2077124398 |
Fax Number: | |
NPI Enumeration Date: | 02/11/2014 |
NPI Last Update Date: | 10/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP2319 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
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 |