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Individual

MARY ELIZABETH JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
SLP

Contact information

Practice address
3857 E DECATUR ST, MESA, AZ 85205-6142
(480) 433-4198
Mailing address
3857 E DECATUR ST, MESA, AZ 85205-6142
(480) 433-4198

Taxonomy

Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
#SLPA9187
AZ
235Z00000X
Speech-Language Pathologist
Primary
TSLP12908
AZ

Other

Enumeration date
12/08/2014
Last updated
04/12/2021
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