Individual
SUSAN T JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, MSC
Contact information
Practice address
3901 RAINBOW BLVD MSC 4043, 2032 SCHOOL OF NURSING, KANSAS CITY, KS 66160-0001
(866) 249-9736
Mailing address
PO BOX 307, STILWELL, KS 66085-0307
(913) 522-4894
(713) 344-9420
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
480
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18427026
IND. BCBS PROVIDER NUMBER
—
Enumeration date
08/26/2006
Last updated
06/12/2009
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