Individual
MS. KENDALL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3485 N DESERT DR STE 105, EAST POINT, GA 30344-5724
(678) 724-7033
(678) 302-7357
Mailing address
3460 SOMERSET TRL SW, ATLANTA, GA 30331-7935
(864) 323-7445
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP008103
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126519G
—
GA
Enumeration date
07/06/2012
Last updated
08/18/2023
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