Doctor Name: | DR. CARLA WOOD JACKSON |
NPI Number: | 1558554055 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D, CCC-SLP |
License Number: | SA 8220 |
Business Practice Address: | 600 W College Ave Fsu Speech & Hearing Clinic Tallahassee, FL - 323061058 |
Business Phone Number: | 8506456567 |
Business Fax Number: | 8506448994 |
Mailing Address: | 600 W College Ave, Fsu Speech & Hearing Clinic TALLAHASSEE |
State: | FL |
Postal Code: | 323061058 |
Phone Number: | 8506456567 |
Fax Number: | 8506448994 |
NPI Enumeration Date: | 08/20/2007 |
NPI Last Update Date: | 08/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA 8220 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
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 |