Healthcare Provider Details

I. General information

NPI: 1396745287
Provider Name (Legal Business Name): MARIE E BYRNE PHD CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 COLLEGE ST MUW-1340
COLUMBUS MS
39701-5800
US

IV. Provider business mailing address

1100 COLLEGE ST MUW-1340
COLUMBUS MS
39701-5800
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-7270
  • Fax: 662-329-7460
Mailing address:
  • Phone: 662-329-7270
  • Fax: 662-329-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS0725
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: