Individual
MRS. EVIAN MICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4055 PRESCOTT RD, BATON ROUGE, LA 70805-5146
(225) 372-2037
Mailing address
9655 JUDI AVE, BATON ROUGE, LA 70815-4923
(225) 938-4445
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8233
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010354707
—
LA
Enumeration date
09/11/2018
Last updated
08/08/2022
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