Healthcare Provider Details

I. General information

NPI: 1346452026
Provider Name (Legal Business Name): TERESA KAY LANEY M.S. CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I-55 N SUITE 291
JACKSON MS
39211
US

IV. Provider business mailing address

1074 LIVINGSTON VERNON RD
FLORA MS
39071-9646
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0859
  • Fax:
Mailing address:
  • Phone: 601-879-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3157
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: