Individual
CELESTE JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
4220 STACKSTONE DR, CUMMING, GA 30041-5644
(404) 641-9019
Mailing address
4220 STACKSTONE DR, CUMMING, GA 30041-5644
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004817
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00836998B
—
GA
Enumeration date
05/05/2006
Last updated
07/09/2007
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