Healthcare Provider Details

I. General information

NPI: 1821248618
Provider Name (Legal Business Name): ANNE M MIZE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

IV. Provider business mailing address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-6777
  • Fax: 800-517-6935
Mailing address:
  • Phone: 601-605-6777
  • Fax: 800-517-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS2290
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: