Organization
NORTHWEST MS SPEECH & HEARING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LANDON LEIGH WALLIS MS, CCC-SLP (OWNER)
(662) 891-2029
Entity
Organization
Contact information
Practice address
445 HIGHWAY 6 E, BATESVILLE, MS 38606-3001
(662) 891-2029
Mailing address
112 OLD LAKE CV, BATESVILLE, MS 38606-7637
(662) 891-2029
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3022
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02701818
—
MS
Enumeration date
10/13/2012
Last updated
06/03/2013
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