Individual
MRS. LISA DAWN MCKINNEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
105 ADAIR ST, RALEIGH COUNTY BOARD OF EDUCATION, BECKLEY, WV 25801
(304) 256-4500
(304) 256-4739
Mailing address
105 THIRD AVENUE, FAYETTEVILLE, WV 25840
(304) 574-2268
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP0084
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7402057000
—
WV
Enumeration date
01/24/2008
Last updated
01/24/2008
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