Individual
KIMBERLY CHRISTINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1570 W RESERVOIR ST, WYTHEVILLE, VA 24382-1500
(276) 228-5411
Mailing address
4897 SUGAR GROVE HWY, SUGAR GROVE, VA 24375-3166
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202008232
VA
Other
Enumeration date
03/15/2019
Last updated
04/30/2020
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