Individual
GENETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11011 CHERRY HILL RD, BELTSVILLE, MD 20705-3801
(301) 572-0600
Mailing address
3715 40TH PL, BRENTWOOD, MD 20722-1610
(301) 461-8221
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
07511
MD
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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