Individual
LESLEY THOMAS ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
314 BRYANT ST, PETAL, MS 39465-3906
(601) 544-0391
Mailing address
314 BRYANT ST, PETAL, MS 39465-3906
(601) 544-0391
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3294
MS
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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