| Doctor Name: | TAWANNA C JACKSON |
| NPI Number: | 1790841450 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSP,CCC-SLP |
| License Number: | SLP005500 |
| Business Practice Address: | 8075 Mall Pkwy Suite 101-332 Lithonia, GA - 300386993 |
| Business Phone Number: | 7703233002 |
| Business Fax Number: | |
| Mailing Address: | 8075 Mall Pkwy, Suite 101-332 LITHONIA |
| State: | GA |
| Postal Code: | 300386993 |
| Phone Number: | 7703233002 |
| Fax Number: | |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP005500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| 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 |