Individual
KELLI BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4805 W 4TH ST, HATTIESBURG, MS 39402-1019
(601) 270-6968
Mailing address
606 CONCART ST, HATTIESBURG, MS 39401-4213
(504) 701-4709
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
06/20/2023
Last updated
06/20/2023
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