Individual
MRS. JACKIE DEESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SPEECH THERAPIST
Contact information
Practice address
580 FARRINGDOM STREET, LUMBERTON, NC 28358
(910) 671-9629
(910) 671-9630
Mailing address
PO BOX 1288, 580 FARRINGDOM STREET, LUMBERTON, NC 28359
(910) 671-9629
(910) 671-9630
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6141
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7412452
—
NC
Enumeration date
05/23/2007
Last updated
05/17/2016
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