Individual
MRS. LAURIE WILKIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP-CCC, SLP
Contact information
Practice address
103 DELAINE WOODS DR, IRMO, SC 29063-8098
(803) 407-8141
Mailing address
103 DELAINE WOODS DR, IRMO, SC 29063-8098
(803) 407-8141
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
526
SC
Other
Enumeration date
03/27/2009
Last updated
03/27/2009
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