Individual
JACKIE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
2200 EDISON ST, BRUSH, CO 80723-1609
(210) 378-5763
Mailing address
11603 CRESTON, SAN ANTONIO, TX 78251-3219
(210) 378-5763
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0002839
CO
Other
Enumeration date
11/21/2017
Last updated
11/21/2017
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