Doctor Name: | MRS. KRISTEN M JACKSON |
NPI Number: | 1174804678 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., CCC-SLP, L-KS |
License Number: | 2043 |
Business Practice Address: | 114 Lockett Ln Saint George, KS - 665359618 |
Business Phone Number: | 7854948676 |
Business Fax Number: | |
Mailing Address: | 114 Lockett Ln, SAINT GEORGE |
State: | KS |
Postal Code: | 665359618 |
Phone Number: | 7854948676 |
Fax Number: | |
NPI Enumeration Date: | 08/29/2011 |
NPI Last Update Date: | 08/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2043 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
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 |