Individual
BROOKE R. JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 SOUTH ST E, TALLADEGA, AL 35160-2411
(256) 761-3201
(256) 761-3485
Mailing address
205 SOUTH ST E, TALLADEGA, AL 35160-2411
(256) 761-3201
(256) 761-3485
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2856
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2856
LICENSE
AL
Enumeration date
11/03/2011
Last updated
11/03/2011
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