Individual
WHITNEY E JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CF-SLP
Contact information
Practice address
4902 W HWY 158, MANILA, AR 72442
(870) 243-3587
Mailing address
4902 W HWY 158, MANILA, AR 72442
(870) 243-3587
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#P8531
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190743721
—
AR
Enumeration date
01/20/2012
Last updated
03/26/2014
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