Doctor Name: | MRS. ROBERTA LYNNE JACKOWIAK |
NPI Number: | 1972826923 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 501 20th St Gunter Hall Rm 0330, Campus Box 55 Greeley, CO - 806396900 |
Business Phone Number: | 9703512012 |
Business Fax Number: | 9703511601 |
Mailing Address: | 501 20th St, Gunter Hall Rm 0330, Campus Box 55 GREELEY |
State: | CO |
Postal Code: | 806396900 |
Phone Number: | 9703512012 |
Fax Number: | 9703511601 |
NPI Enumeration Date: | 03/04/2010 |
NPI Last Update Date: | 03/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
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 |