Provider Demographics
NPI:1205981156
Name:JACKSON, MARGARET KATHLEEN (MS, CCCSLP)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:KATHLEEN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 BLAZEDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6344
Mailing Address - Country:US
Mailing Address - Phone:314-920-6248
Mailing Address - Fax:636-386-0960
Practice Address - Street 1:543 BLAZEDWOOD DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-6344
Practice Address - Country:US
Practice Address - Phone:314-920-6248
Practice Address - Fax:636-386-0960
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist