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General NPI Number Information
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NPI Number | 1235502196
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Entity Type | Organization
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Legal Business Name | DELTA SPEECH-LANGUAGE PATHOLOGY, PLLC
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Dates
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Enumeration Date | 11/01/2015
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Last Update Date | 11/01/2015
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Provider Practice Location Address
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Address Line | 139 W LAKE LEE RD
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City | GREENVILLE
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State | MS
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Zip | 38701-9573
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Country | US
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Telephone | 662-822-1322
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Fax |
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Provider Business Mailing Address
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Address Line | 139 W LAKE LEE RD
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City | GREENVILLE
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State | MS
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Zip | 38701-9573
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Country | US
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Telephone | 662-822-1322
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST/OWNER
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Name | MRS. HEATHER MELISSA MANGRUM
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Credential | MS, CCC-SLP
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Telephone | 662-822-1322
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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 |
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License Number State | MS
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