Provider Demographics
NPI:1205363900
Name:JACKSON, LISETTE (AUD)
Entity Type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1766
Mailing Address - Country:US
Mailing Address - Phone:972-838-1300
Mailing Address - Fax:
Practice Address - Street 1:4201 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 270
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1766
Practice Address - Country:US
Practice Address - Phone:972-838-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist