Individual
MRS. STACEY LEIGH MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
5600 GOODMAN RD STE D, OLIVE BRANCH, MS 38654-7002
(662) 895-4545
(662) 895-4546
Mailing address
5600 GOODMAN RD STE D, OLIVE BRANCH, MS 38654-7002
(662) 895-4545
(662) 895-4546
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2304
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09877809
—
MS
Enumeration date
07/23/2006
Last updated
07/08/2007
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