| Doctor Name: | MS. DEBRA MARLENE JACKSON |
| NPI Number: | 1245282904 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS-CCC/SLP |
| License Number: | 146003388 |
| Business Practice Address: | 1219 Troy Rd Edwardsville, IL - 620252363 |
| Business Phone Number: | 6189607696 |
| Business Fax Number: | 1309216271 |
| Mailing Address: | 1219 Troy Rd, EDWARDSVILLE |
| State: | IL |
| Postal Code: | 620252363 |
| Phone Number: | 6189607696 |
| Fax Number: | 1309216271 |
| NPI Enumeration Date: | 05/17/2006 |
| NPI Last Update Date: | 08/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 146003388 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| 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 |