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Individual

MELANIE JORDAN WALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
402B LEGACY PARK DR, RIDGELAND, MS 39157-4315
(769) 233-7154
Mailing address
402 LEGACY PARK DR, RIDGELAND, MS 39157
(769) 233-7154

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-273581
MS

Other

Enumeration date
01/19/2024
Last updated
01/19/2024
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