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General NPI Number Information
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NPI Number | 1780080341
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Entity Type | Organization
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Legal Business Name | DREAMCATCHER SPEECH AND LANGUAGE LLC
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 146 YOCONA RIDGE RD
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City | OXFORD
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State | MS
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Zip | 38655-6904
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Country | US
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Telephone | 662-934-9885
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Fax |
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Provider Business Mailing Address
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Address Line | 146 YOCONA RIDGE RD
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City | OXFORD
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State | MS
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Zip | 38655-6904
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Country | US
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Telephone | 662-934-9885
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | ANDREA CAROL STATEN
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Credential | M.S., CCC-SLP
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Telephone | 662-934-9885
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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 | S2354
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License Number State | MS
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