Doctor Name: | SUSAN T JACKSON |
NPI Number: | 1255449658 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD, MSC |
License Number: | 480 |
Business Practice Address: | 3901 Rainbow Blvd Msc 4043 2032 School Of Nursing Kansas City, KS - 661600001 |
Business Phone Number: | 8662499736 |
Business Fax Number: | |
Mailing Address: | Po Box 307, STILWELL |
State: | KS |
Postal Code: | 660850307 |
Phone Number: | 9135224894 |
Fax Number: | 7133449420 |
NPI Enumeration Date: | 08/26/2006 |
NPI Last Update Date: | 06/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 480 |
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 |