Individual
MIA JAQUAY KIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
7145 SWINNEA ROAD, SUITE # 1, SOUTHAVEN, MS 38671-6013
(662) 349-2370
(662) 349-2384
Mailing address
PO BOX 552, SOUTHAVEN, MS 38671-0006
(662) 349-2370
(662) 349-2384
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
3231
TN
235Z00000X
Speech-Language Pathologist
Primary
S3061
MS
Other
Enumeration date
02/01/2008
Last updated
11/16/2010
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