Healthcare Provider Details

I. General information

NPI: 1083782775
Provider Name (Legal Business Name): MS SCHOOL FOR THE DEAF AND BLIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 EASTOVER DR
JACKSON MS
39211-6315
US

IV. Provider business mailing address

1253 EASTOVER DR
JACKSON MS
39211-6315
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-8036
  • Fax: 601-984-8030
Mailing address:
  • Phone: 601-984-8036
  • Fax: 601-984-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAO661
License Number StateMS

VIII. Authorized Official

Name: DR. ROSIE PRIDGEN
Title or Position: INTERIM SUPERINTENDENT MSD
Credential:
Phone: 601-984-8203