Individual
LISA NICOLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A. SLPA
Contact information
Practice address
3200 TROUP HWY STE, 120, TYLER, TX 75701
(903) 253-0095
Mailing address
3200 TROUP HWY STE 120, TYLER, TX 75701-8364
(903) 253-0095
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
37923
TX
Other
Enumeration date
06/24/2014
Last updated
06/24/2014
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