| NPI | 1710239843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANDON LEIGH WALLIS Owner 662-891-2029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MS S3022) |
| Enumeration Date | 2012-10-13 |
| Last Update Date | 2013-06-03 |