Individual
LOIS L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
380 LAKELAND DR, ATHENS, GA 30607-2092
(706) 224-1178
Mailing address
380 LAKELAND DR, ATHENS, GA 30607-2092
(706) 224-1178
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
109298
TX
235Z00000X
Speech-Language Pathologist
Primary
SLP008303
GA
235Z00000X
Speech-Language Pathologist
SP-1016
WY
Other
Enumeration date
02/07/2014
Last updated
03/12/2022
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