Individual
MRS. LAKEISHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 CREEKSTONE RDG STE 25, WOODSTOCK, GA 30188-3744
(404) 939-5976
Mailing address
744 NOAH DR STE 113-374, JASPER, GA 30143-8705
(404) 939-5976
(404) 920-3496
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006166
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003219302A
—
GA
Enumeration date
10/28/2015
Last updated
10/24/2023
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