Individual
JILL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
N4901 DAM RD, DELAVAN, WI 53115-2927
(262) 740-2170
(262) 740-7201
Mailing address
N4901 DAM RD, DELAVAN, WI 53115-2927
(262) 740-2170
(262) 740-7201
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2132-154
WI
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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