Provider Demographics
NPI:1295866762
Name:JACKSON, OLGA WESTLEY (MS, SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:WESTLEY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 BENE ST
Mailing Address - Street 2:P O BOX 246
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-1248
Mailing Address - Country:US
Mailing Address - Phone:985-839-6890
Mailing Address - Fax:
Practice Address - Street 1:1303 BENE ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1248
Practice Address - Country:US
Practice Address - Phone:985-839-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1712680Medicaid