Provider Demographics
NPI:1639833023
Name:JACKSON SPEECH & LANGUAGE SERVICES
Entity Type:Organization
Organization Name:JACKSON SPEECH & LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:508-698-7973
Mailing Address - Street 1:16 CHESTNUT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1462
Mailing Address - Country:US
Mailing Address - Phone:508-698-7973
Mailing Address - Fax:508-698-1010
Practice Address - Street 1:16 CHESTNUT ST STE 102
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1462
Practice Address - Country:US
Practice Address - Phone:508-698-7973
Practice Address - Fax:508-698-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty