Individual
MARY CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
404 LYNNFIELD DR, AMORY, MS 38821-1208
(662) 369-5017
Mailing address
404 LYNNFIELD DR, AMORY, MS 38821-1208
(662) 369-5017
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SO806
MS
Other
Enumeration date
09/19/2016
Last updated
09/19/2016
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