Organization
POPLAR BLUFF SCHOOL DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN HICKS (MEDICAID SECRETARY)
(573) 785-6707
Entity
Organization
Contact information
Practice address
1110 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3336
(573) 785-6707
Mailing address
1110 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3336
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2009013434
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2009013434
SPEECH AND LANGAUGE
MO
05
—
MO29-64
—
MO
Enumeration date
08/26/2009
Last updated
08/26/2009
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