Individual
RENITA MONAE ISOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
7160 TCHULAHOMA RD STE 4, SOUTHAVEN, MS 38671-9266
(662) 544-0156
Mailing address
PO BOX 5663, HOLLY SPRINGS, MS 38634-5663
(662) 544-0156
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3566
MS
Other
Enumeration date
06/12/2013
Last updated
06/12/2013
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