| Doctor Name: | LAURA LONG JACKSON |
| NPI Number: | 1740340181 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 19440 |
| Business Practice Address: | 515 W Lingleville Rd Stephenville, TX - 764012211 |
| Business Phone Number: | 2549653611 |
| Business Fax Number: | |
| Mailing Address: | 1803 W Spanish Oak Dr, GRANBURY |
| State: | TX |
| Postal Code: | 760482906 |
| Phone Number: | 8175790401 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 08/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 19440 |
| 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 |