Healthcare Provider Details

I. General information

NPI: 1952527467
Provider Name (Legal Business Name): THE UNIVERSITY OF MISSISSIPPI SPEECH AND HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SOUTH LAMAR BOULEVARD
OXFORD MS
38655
US

IV. Provider business mailing address

PO BOX 1848
UNIVERSITY MS
38677-1848
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-7271
  • Fax: 662-915-7263
Mailing address:
  • Phone: 662-915-7271
  • Fax: 662-915-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LENNETTE J IVY
Title or Position: DEPARTMENT CHAIR
Credential: CCC-SLP, PH.D.
Phone: 662-915-7271