Doctor Name: | KIMBERLY D. JACKSON |
NPI Number: | 1871836395 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SLP008106 |
Business Practice Address: | 270 Creekview Blvd Covington, GA - 300167693 |
Business Phone Number: | 4044349595 |
Business Fax Number: | 7707879345 |
Mailing Address: | 270 Creekview Blvd, COVINGTON |
State: | GA |
Postal Code: | 300167693 |
Phone Number: | 4044349595 |
Fax Number: | 7707879345 |
NPI Enumeration Date: | 04/03/2013 |
NPI Last Update Date: | 04/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP008106 |
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 |