Healthcare Provider Details

I. General information

NPI: 1750669727
Provider Name (Legal Business Name): DOROTHY EVA ABRAMS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY EVA JONES CCC-SLP

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I 55 N STE 291
JACKSON MS
39211-5996
US

IV. Provider business mailing address

206 CRESCENT RIDGE DR
MADISON MS
39110-7073
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0870
  • Fax:
Mailing address:
  • Phone: 662-315-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3444
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: