Individual
MS. JACQUELINE MARIE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
6229 LAWNTON ST, PHILADELPHIA, PA 19128-2601
(215) 487-2995
Mailing address
6229 LAWNTON ST, PHILADELPHIA, PA 19128-2601
(215) 487-2995
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL002851L
PA
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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