Individual
LONDYN ANDREA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15500 BENITA FITZGERALD DR, WOODBRIDGE, VA 22193-8523
(703) 583-4195
Mailing address
4059 TARPON LN, WOODBRIDGE, VA 22193-2332
(703) 600-9302
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2204000315
VA
Other
Enumeration date
08/07/2019
Last updated
09/04/2019
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