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NPI Code Detail

MEDICARE: COASTAL SPEECH, LANGUAGE, AND LITERACY, LLC

MEDICARE: COASTAL SPEECH, LANGUAGE, AND LITERACY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0700XHearing and Speech Clinic/Center

General Provider Information

NPI Number : 1487338455
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL SPEECH, LANGUAGE, AND LITERACY, LLC
Provider Business Mailing Address
First Line : 20250 WHITE RD
Second Line :
City : VANCLEAVE
State : MS
Zip : 39565-6430
Country : US
Telephone Number : 228-218-3362
Fax Number : 228-366-9062
Provider Business Practice Location Address
First Line : 4214 BIENVILLE BLVD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5975
Country : US
Telephone Number : 228-218-3362
Fax Number : 228-366-9062
Authorized Official
Title or Position : SPEECH LANGUAGE PATHOLOGIST
Name : MRS. HOLLY MIXON
Credential : MS CCC - SLP
Telephone Number : 228-218-3362
Provider Enumeration Date : 06/12/2023
Last Update Date : 07/06/2023

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Directions to “COASTAL SPEECH, LANGUAGE, AND LITERACY, LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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