Individual
TAWANNA C JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP,CCC-SLP
Contact information
Practice address
8075 MALL PKWY, SUITE 101-332, LITHONIA, GA 30038-6993
(770) 323-3002
Mailing address
8075 MALL PKWY, SUITE 101-332, LITHONIA, GA 30038-6993
(770) 323-3002
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005500
GA
Other
Enumeration date
12/28/2006
Last updated
07/09/2007
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