Individual
MRS. ANGELA DAWN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
603 ASHLEY DR, SIKESTON, MO 63801-3954
(573) 471-6653
Mailing address
603 ASHLEY DR, SIKESTON, MO 63801-3954
(573) 471-6653
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
118154
MO
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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