Individual
MRS. CHARLEEN A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
9 DIVISION ST, NORWICH, NY 13815-2030
(607) 244-1707
Mailing address
9 DIVISION STREET, NORWICH, NY 13815
(607) 244-1707
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
006838
NY
Other
Enumeration date
05/03/2010
Last updated
05/03/2010
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