Individual
MRS. SHERLEY LAURIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
300 LESTER MILL RD, LOCUST GROVE, GA 30248-5306
(404) 480-0489
(678) 586-5828
Mailing address
4047 MADISON ACRES DR, LOCUST GROVE, GA 30248-4375
(828) 399-0979
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
010047
GA
235Z00000X
Speech-Language Pathologist
30732
FL
235Z00000X
Speech-Language Pathologist
7074
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003230088A
—
GA
Enumeration date
06/05/2009
Last updated
09/15/2022
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