Individual
CARLY B JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
12414 S ANDRUS RD, CHENEY, WA 99004-8607
(509) 559-4507
(509) 559-4517
Mailing address
12414 S ANDRUS RD, CHENEY, WA 99004-8607
(509) 559-4507
(509) 559-4517
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL60083435
WA
Other
Enumeration date
11/12/2009
Last updated
09/13/2013
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