Individual
BIANCA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1832 STANOCOLA DR, BATON ROUGE, LA 70807-3047
(225) 614-6773
Mailing address
1832 STANOCOLA DR, BATON ROUGE, LA 70807-3047
(225) 614-6773
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
05/26/2015
Last updated
07/31/2019
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