Individual
SUSAN FORTENBERRY REEVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1605 S 28TH AVE, HATTIESBURG, MS 39402-3110
(601) 579-3310
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-3310
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3695
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09580361
—
MS
Enumeration date
08/07/2013
Last updated
08/24/2020
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