| Doctor Name: | CARLY B JACKSON |
| NPI Number: | 1780911743 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CCC-SLP |
| License Number: | LL60083435 |
| Business Practice Address: | 12414 S Andrus Rd Cheney, WA - 990048607 |
| Business Phone Number: | 5095594507 |
| Business Fax Number: | 5095594517 |
| Mailing Address: | 12414 S Andrus Rd, CHENEY |
| State: | WA |
| Postal Code: | 990048607 |
| Phone Number: | 5095594507 |
| Fax Number: | 5095594517 |
| NPI Enumeration Date: | 11/12/2009 |
| NPI Last Update Date: | 09/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | LL60083435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| 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 |