Healthcare Provider Details

I. General information

NPI: 1962333963
Provider Name (Legal Business Name): JILLIAN HODGES MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HIGHWAY 82 W STE A
INDIANOLA MS
38751-2150
US

IV. Provider business mailing address

406 POPLAR ST
GREENWOOD MS
38930-3624
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-3800
  • Fax:
Mailing address:
  • Phone: 662-897-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS-5018
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: