Individual
MS. LANDON LEIGH WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
112 OLD LAKE CV, BATESVILLE, MS 38606-7637
(662) 891-2029
Mailing address
112 OLD LAKE CV, BATESVILLE, MS 38606-7637
(662) 891-2029
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3022
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0020229
—
MS
Enumeration date
07/20/2007
Last updated
07/19/2012
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