Individual
MRS. KATHLEEN WENTLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC- SLP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-7399
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 992-6820
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2297
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07030001
—
MS
Enumeration date
10/10/2008
Last updated
07/17/2013
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