Individual
ALISA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2015 AYRSLEY TOWN BLVD STE 202, CHARLOTTE, NC 28273-4068
(704) 750-0675
(704) 831-5369
Mailing address
2015 AYRSLEY TOWN BLVD STE 202, CHARLOTTE, NC 28273-4068
(704) 750-0675
(704) 831-5369
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
30004511
NC
Other
Enumeration date
09/15/2025
Last updated
09/15/2025
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