Individual
MRS. JESSICA ROSE BRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
23 MASON ST, LAUREL, MS 39440-4437
(601) 399-0539
(601) 399-1617
Mailing address
106 WILDWOOD TRL, PETAL, MS 39465-2673
(601) 498-5591
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3023
MS
Other
Enumeration date
03/13/2007
Last updated
03/06/2009
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