Provider Demographics
NPI:1760798987
Name:AMO JACKSON, APRYL N
Entity Type:Individual
Prefix:
First Name:APRYL
Middle Name:N
Last Name:AMO 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 1:3500 MIDDLE CHESHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2466
Mailing Address - Country:US
Mailing Address - Phone:585-905-4185
Mailing Address - Fax:
Practice Address - Street 1:3255 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2806
Practice Address - Country:US
Practice Address - Phone:585-427-7610
Practice Address - Fax:585-427-7410
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist