Individual
LAURIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
122 ASHLEY HILL DR, WEXFORD, PA 15090-9457
(703) 955-0716
Mailing address
122 ASHLEY HILL DR, WEXFORD, PA 15090-9457
(703) 955-0716
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL011613
PA
Other
Enumeration date
06/08/2018
Last updated
06/08/2018
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