Individual
HEATHER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
4460 CELEBRATION BLVD, ACWORTH, GA 30101-1105
(770) 324-2863
Mailing address
PO BOX 2815, CARTERSVILLE, GA 30120-1697
(770) 324-2863
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006307
GA
Other
Enumeration date
08/23/2018
Last updated
08/23/2018
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