Provider Demographics
NPI:1437494556
Name:JACKSON, SUSAN (SLPA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1317
Mailing Address - Country:US
Mailing Address - Phone:360-618-6240
Mailing Address - Fax:
Practice Address - Street 1:315 N FRENCH AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1317
Practice Address - Country:US
Practice Address - Phone:360-618-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant