Individual
MRS. DORTHEEN DOUGLAS WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
7305 GREEN ASH DR, OLIVE BRANCH, MS 38654-4383
(901) 870-7997
Mailing address
7305 GREEN ASH DR, OLIVE BRANCH, MS 38654-4383
(901) 870-7997
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0000003190
TN
Other
Enumeration date
01/04/2011
Last updated
01/04/2011
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