Individual
CODIE JACLYN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
668 OLD SALT RD, SUMRALL, MS 39482-4232
(601) 270-6968
(601) 336-5255
Mailing address
17 E CHERRY, SUMRALL, MS 39482-0400
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S-4294
MS
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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