Individual
PHYLLIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
S.T.
Contact information
Practice address
9384 FLORIDA BOULEVARD, SUITE F, WALKER, LA 70785
(225) 791-0911
(225) 791-1977
Mailing address
9384 FLORIDA BOULEVARD, SUITE F, WALKER, LA 70785
(225) 791-0911
(225) 791-1977
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
941
LA
Other
Enumeration date
01/17/2007
Last updated
07/08/2007
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