Provider Demographics
NPI:1407151848
Name:JACKSON, ANNETTE L (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MECHANIC ST
Mailing Address - Street 2:SUITE B4
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-4006
Mailing Address - Country:US
Mailing Address - Phone:508-698-7973
Mailing Address - Fax:
Practice Address - Street 1:38 MECHANIC ST
Practice Address - Street 2:SUITE B4
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-4006
Practice Address - Country:US
Practice Address - Phone:508-698-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist