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General NPI Number Information
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NPI Number | 1487338455
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Entity Type | Organization
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Legal Business Name | COASTAL SPEECH, LANGUAGE, AND LITERACY, LLC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 4214 BIENVILLE BLVD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-5975
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Country | US
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Telephone | 228-218-3362
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Fax | 228-366-9062
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Provider Business Mailing Address
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Address Line | 20250 WHITE RD
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City | VANCLEAVE
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State | MS
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Zip | 39565-6430
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Country | US
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Telephone | 228-218-3362
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Fax | 228-366-9062
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. HOLLY MIXON
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Credential | MS CCC - SLP
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Telephone | 228-218-3362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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