Individual
DAVID MAX JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
81 PEREGRINE CT, W LAFAYETTE, IN 47906-5073
(765) 426-0220
Mailing address
81 PEREGRINE CT, W LAFAYETTE, IN 47906-5073
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22002292A
IN
Other
Enumeration date
09/01/2006
Last updated
07/08/2007
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