Organization
SPEECH PATHOLOGY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE CRAIN (OWNER)
(662) 226-0101
Entity
Organization
Contact information
Practice address
1321 SUNSET DRIVE, STE DD, GRENADA, MS 38901
(662) 226-0101
Mailing address
PO BOX 891, GRENADA, MS 38902-0891
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SO798
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016200
—
MS
Enumeration date
12/03/2007
Last updated
12/03/2007
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