| NPI | 1013475680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER BANKS Speech Language Pathologist 228-239-0522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2022-11-01 |