Individual
MICKALA WASHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
606 SILVER CV, PEARL, MS 39208-5003
(601) 942-3027
Mailing address
606 SILVER CV, PEARL, MS 39208-5003
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S-4690
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S-4690
—
MS
Enumeration date
03/09/2022
Last updated
03/09/2022
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