Healthcare Provider Details

I. General information

NPI: 1558554436
Provider Name (Legal Business Name): VIRGINIA TURNER HAYNES CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 NORTHTOWN DR TRINITY REHAB, SUITE 110
JACKSON MS
39211
US

IV. Provider business mailing address

13 NORTHTOWN DR TRINITY REHAB, SUITE 110
JACKSON MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-206-9195
  • Fax: 601-957-8391
Mailing address:
  • Phone: 601-206-9195
  • Fax: 601-957-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS2559
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: