Individual
TERESA A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
PEMISCOT CO SPECIAL SCHOOL DISTRICT, 1317 STATE HIGHWAY 84, HAYTI, MO 63851-1666
(573) 359-0021
(573) 359-6525
Mailing address
1317 STATE HIGHWAY 84, HAYTI, MO 63851-1666
(573) 359-0021
(573) 359-6525
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
109221
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
464450006
—
MO
Enumeration date
04/27/2007
Last updated
02/23/2009
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