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General NPI Number Information
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NPI Number | 1235894627
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Entity Type | Organization
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Legal Business Name | VARIATION OF SPEECH
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 1508 HUNTLEY BLVD
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City | MADISON
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State | MS
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Zip | 39110-6336
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Country | US
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Telephone | 601-507-0653
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Fax | 601-790-7137
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Provider Business Mailing Address
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Address Line | 1508 HUNTLEY BLVD
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City | MADISON
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State | MS
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Zip | 39110-6336
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Country | US
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Telephone | 601-507-0653
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Fax | 601-790-7137
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Authorized Official
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Title or Position | CEO
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Name | VERNITA A BARTON-MCGOWAN
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Credential | CCC-SLP
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Telephone | 601-507-0653
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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 |
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