| Doctor Name: | SAMANTHA JACKSON |
| NPI Number: | 1558615583 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 107527 |
| Business Practice Address: | 4609 San Dario Ave Ste 9 Laredo, TX - 780415773 |
| Business Phone Number: | 9567236600 |
| Business Fax Number: | 9567236614 |
| Mailing Address: | 4609 San Dario Ave Ste 9, LAREDO |
| State: | TX |
| Postal Code: | 780415773 |
| Phone Number: | 9567236600 |
| Fax Number: | 9567236614 |
| NPI Enumeration Date: | 10/29/2012 |
| NPI Last Update Date: | 10/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 107527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| 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 |