Provider Demographics
NPI:1619216850
Name:JACKSON, JESSICA LINDSAY
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LINDSAY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132-9105
Mailing Address - Country:US
Mailing Address - Phone:501-413-9486
Mailing Address - Fax:
Practice Address - Street 1:2905 RIVER RD
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:AR
Practice Address - Zip Code:72132-9105
Practice Address - Country:US
Practice Address - Phone:501-413-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant