Individual
DEMETRIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
157 CORAL DR, BRUNSWICK, GA 31523-8951
(912) 689-4382
(888) 875-2884
Mailing address
PO BOX 2246, BRUNSWICK, GA 31521-2246
(912) 689-4382
(888) 875-2884
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007195
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
658178836A
—
GA
Enumeration date
06/02/2010
Last updated
02/04/2022
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