Healthcare Provider Details

I. General information

NPI: 1336270602
Provider Name (Legal Business Name): KABY PLITT MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 TCHULAHOMA RD BLDG. B SUITE 4
SOUTHAVEN MS
38671-9266
US

IV. Provider business mailing address

7160 TCHULAHOMA RD BLDG. B SUITE 4
SOUTHAVEN MS
38671-9266
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-2733
  • Fax: 662-536-1849
Mailing address:
  • Phone: 662-349-2733
  • Fax: 662-536-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS2898
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: