Provider Demographics
NPI:1982215885
Name:JACKSON, HELEN (MAT, MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MAT, MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 HENRY CLOWER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5707
Mailing Address - Country:US
Mailing Address - Phone:770-995-9600
Mailing Address - Fax:678-383-4556
Practice Address - Street 1:700 OGLETHORPE AVE STE A2
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2221
Practice Address - Country:US
Practice Address - Phone:770-995-9600
Practice Address - Fax:678-383-4556
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist