Individual
MR. JOHN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
1901 BRIAR RIDGE RD, TUPELO, MS 38804-5903
(662) 844-0675
Mailing address
PO BOX 428, ORCHARD PARK, NY 14127-0428
(662) 397-5526
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3446
MS
Other
Enumeration date
08/05/2014
Last updated
08/05/2014
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