Provider Demographics
NPI:1235439423
Name:NORMAN, PAULA STACY (SLT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:STACY
Last Name:NORMAN
Suffix:
Gender:F
Credentials:SLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 W THIRD ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-4006
Mailing Address - Country:US
Mailing Address - Phone:601-469-1001
Mailing Address - Fax:601-469-1009
Practice Address - Street 1:813 W THIRD ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-4006
Practice Address - Country:US
Practice Address - Phone:601-469-1001
Practice Address - Fax:601-469-1009
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS1016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist