Healthcare Provider Details

I. General information

NPI: 1427770825
Provider Name (Legal Business Name): MADALINE BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VETERANS DR
OXFORD MS
38655-3578
US

IV. Provider business mailing address

599C STEED RD
RIDGELAND MS
39157-1707
US

V. Phone/Fax

Practice location:
  • Phone: 662-259-5516
  • Fax: 662-259-5517
Mailing address:
  • Phone: 601-605-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS4829
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: