Individual
MADORA MCKINNEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1901 MISSION 66, SUITE A, VICKSBURG, MS 39180-3711
(601) 638-4076
(601) 883-2232
Mailing address
6100 OLD BRANDON RD, BRANDON, MS 39042-2543
(601) 638-4076
(601) 883-2232
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3182
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050976
BCBS OF MISSISSIPPI
MS
Enumeration date
12/26/2007
Last updated
04/17/2018
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