Organization
INNOVATIVE THERAPY MATTERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIA L JACKSON CCC-SLP (OWNER)
(912) 571-6022
Entity
Organization
Contact information
Practice address
157 CORAL DR, BRUNSWICK, GA 31523-8951
(912) 571-6022
Mailing address
PO BOX 2246, BRUNSWICK, GA 31521-2246
(912) 571-6022
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007195
GA
Other
Enumeration date
04/28/2016
Last updated
02/24/2022
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