| NPI | 1780080341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA CAROL STATEN Speech Language Pathologist 662-934-9885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MS S2354) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2014-11-10 |