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General NPI Number Information
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NPI Number | 1528527405
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Entity Type | Organization
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Legal Business Name | KIM S. HAVARD, MS CCC-SLP LLC
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 98 QUAIL HOLLOW DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-6008
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Country | US
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Telephone | 601-408-1365
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Fax | 601-300-3015
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Provider Business Mailing Address
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Address Line | 98 QUAIL HOLLOW DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-6008
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Country | US
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Telephone | 601-408-1365
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Fax | 601-300-3015
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. KIM S. HAVARD
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Credential | MS CCC-SLP
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Telephone | 601-408-1365
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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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