Individual
REBECCA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
6524 HANCOCK AVE, SAINT LOUIS, MO 63139-2157
(314) 252-0807
Mailing address
6524 HANCOCK AVE, SAINT LOUIS, MO 63139-2157
(314) 252-0807
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2012019166
MO
235Z00000X
Speech-Language Pathologist
Primary
2013029913
MO
Other
Enumeration date
05/11/2013
Last updated
07/13/2022
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