Individual
MICHAEL ANN TALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3077 HIGHWAY 371 N, MANTACHIE, MS 38855-7274
(662) 282-4949
(662) 282-4955
Mailing address
3077 HIGHWAY 371 N, MANTACHIE, MS 38855-7274
(662) 282-4949
(662) 282-4955
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3683
MS
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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