Individual
HEATHER EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
53 REDFERN TRL, PETAL, MS 39465-2672
(601) 520-2352
Mailing address
53 REDFERN TRL, PETAL, MS 39465-2672
(601) 520-2352
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S-4734
MS
Other
Enumeration date
01/06/2025
Last updated
01/06/2025
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