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General NPI Number Information
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NPI Number | 1477282002
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Entity Type | Organization
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Legal Business Name | MASTER MINDS DYSLEXIA CENTER, LLC
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1630 GOODMAN RD E STE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9556
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Country | US
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Telephone | 662-782-5330
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Fax | 662-782-5329
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Provider Business Mailing Address
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Address Line | 1630 GOODMAN RD E STE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9556
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Country | US
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Telephone | 662-782-5330
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Fax | 662-782-5329
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Authorized Official
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Title or Position | CO-FOUNDER, SLP
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Name | MEGAN GIVENS
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Credential | M.S. CCC-SLP
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Telephone | 662-643-3619
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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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