Provider Demographics
NPI:1609048735
Name:JACKSON, KATHRYN MARTIN (BSE,MED)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARTIN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BSE,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 E ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5713
Mailing Address - Country:US
Mailing Address - Phone:479-750-8730
Mailing Address - Fax:479-750-8733
Practice Address - Street 1:1879 E ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5713
Practice Address - Country:US
Practice Address - Phone:479-750-8730
Practice Address - Fax:479-750-8733
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist