Individual
MRS. KELLY GREEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
S.L.P.
Contact information
Practice address
5314 MOSS OAK TRL, LAKE PARK, GA 31636-3300
(386) 362-8564
Mailing address
5314 MOSS OAK TRL, LAKE PARK, GA 31636-3300
(386) 362-8564
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA8681
FL
Other
Enumeration date
07/17/2006
Last updated
01/27/2025
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