Individual
MRS. EMILY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1600 FOREST AVE, PORTLAND, ME 04103-1314
(207) 874-8271
Mailing address
519 PREBLE ST, SOUTH PORTLAND, ME 04106-5018
(207) 712-4398
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP2319
ME
Other
Enumeration date
02/11/2014
Last updated
10/29/2014
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