Individual
MS. STACIE WENDEL ROBERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1417 LELIA DR, JACKSON, MS 39216-4721
(601) 982-7827
(601) 982-0080
Mailing address
613 WINTERIDGE PL, RIDGELAND, MS 39157-4144
(601) 720-1878
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S4008
MS
Other
Enumeration date
06/02/2017
Last updated
06/02/2017
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