Individual
MRS. LISA ANN JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
1104 EAST GRACE STREET, RENSSELAER, IN 47978-3211
(219) 866-5141
(219) 866-3234
Mailing address
1104 EAST GRACE STREET, RENSSELAER, IN 47978-3211
(219) 866-5141
(219) 866-3234
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22002369A
IN
Other
Enumeration date
05/23/2006
Last updated
07/08/2007
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