Provider Demographics
NPI:1659581882
Name:JACKSON, LINDA C (IBCLC, LCCE)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:JACKSON
Suffix:
Gender:F
Credentials:IBCLC, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N BECKLEY AVE
Mailing Address - Street 2:11 BT
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1201
Mailing Address - Country:US
Mailing Address - Phone:214-947-1161
Mailing Address - Fax:214-947-1116
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:11 BT
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-1161
Practice Address - Fax:214-947-1116
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist