Individual
MRS. MOLLY JO MACKENZIE MCCLESKEY DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
207 W JACKSON ST, RIDGELAND, MS 39157-2355
(601) 362-0859
Mailing address
209 FLETCHERS CHAPEL RD, BENTONIA, MS 39040-9054
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S4759
MS
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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