Individual
ANNA GRACE TIDMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5960 GETWELL RD STE 212D, SOUTHAVEN, MS 38672-7320
(662) 228-0130
Mailing address
2950 DOVE CV, HERNANDO, MS 38632-7640
(662) 545-1006
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S5240
MS
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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