Individual
MRS. JO ANNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., C.C.C- SLP
Contact information
Practice address
1401 8TH ST., SPRINGER, NM 87747
(505) 483-3444
(505) 483-5530
Mailing address
RR 1 BOX 78, SPRINGER, NM 87747-9704
(505) 483-5558
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
991
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000J2837
—
NM
Enumeration date
04/25/2006
Last updated
07/08/2007
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