Lois Jackson

NPI 1740604032 - Speech-Language Pathologist - 235Z00000X

NPI Details
NPI 1740604032
Gender Female
Enumeration Date 02/07/2014
Last Updated 03/01/2014
Entity Type Individual
Active Over 2 years ago
Practice Location
5535 S WILLIAMSON BLVD
SUITE 774
PORT ORANGE FL, 32128-8311, US
Phone (800) 330-7711
Fax
Business Location
77 RIDGE CREEK DR
NICHOLSON GA, 30565-3256, US
Phone
Fax
Toxanomy
Taxonomy Code 235Z00000X
License State Texas
License Number 109298
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According to our database, Lois Jackson NPI is 1740604032, taxonomy code is 235Z00000X and license number is 109298, license state is located at Texas. Lois Jackson physically located at 5535 S Williamson Blvd, Port Orange FL, 32128-8311. NPI Number Lois Jackson has the Individual type.

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1740604032 NPI number is provided on an as is basis without warranty of any kind. 1740604032 is maintained by the National Plan & Provider Enumeration System. The contents of Lois Jackson are for informational purposes only.