Individual
MISS TIONNA ALEXIS TINA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
130 SWAN LAKE CV, JACKSON, MS 39212-5332
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S-5375
MS
Other
Enumeration date
11/24/2025
Last updated
12/01/2025
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