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General NPI Number Information
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NPI Number | 1083062889
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Entity Type | Organization
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Legal Business Name | SPEECH DEPOT
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 665 S PEAR ORCHARD RD SUITE 106-185
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone | 601-757-6954
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Fax |
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Provider Business Mailing Address
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Address Line | 665 S PEAR ORCHARD RD SUITE 106-185
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. JAMEKA HOOKS-TENORT
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Credential | M.S., CCC-SLP
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Telephone | 769-798-7378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S3351
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License Number State | MS
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