Individual
LISA FRATESI IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC/SLP
Contact information
Practice address
206 GEORGE HALL, REBEL DRIVE, UNIVERSITY, MS 38677-8800
(662) 915-5291
(662) 915-7263
Mailing address
206 GEORGE HALL, REBEL DRIVE, UNIVERSITY, MS 38677-8800
(662) 915-5291
(662) 915-7263
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2411
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03275793
—
MS
Enumeration date
08/21/2007
Last updated
10/22/2012
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