| Doctor Name: | MRS. LISA DAWN MCKINNEY JACKSON |
| NPI Number: | 1285811984 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CCC SLP |
| License Number: | SLP0084 |
| Business Practice Address: | 105 Adair St Raleigh County Board Of Education Beckley, WV - 25801 |
| Business Phone Number: | 3042564500 |
| Business Fax Number: | 3042564739 |
| Mailing Address: | 105 Third Avenue, FAYETTEVILLE |
| State: | WV |
| Postal Code: | 25840 |
| Phone Number: | 3045742268 |
| Fax Number: | |
| NPI Enumeration Date: | 01/24/2008 |
| NPI Last Update Date: | 01/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP0084 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| 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 |