Individual
JUSTICE IVY HAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1070 WILSON RDG, LAKE CORMORANT, MS 38641-9486
(901) 463-8873
Mailing address
1070 WILSON RDG, LAKE CORMORANT, MS 38641-9486
(901) 463-8873
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
TN
Other
Enumeration date
03/08/2023
Last updated
03/08/2023
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