Provider Demographics
NPI:1376719005
Name:TOTS TO TEENS COMMUNICATION THERAPY
Entity Type:Organization
Organization Name:TOTS TO TEENS COMMUNICATION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THERIONT
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:601-799-4065
Mailing Address - Street 1:215 TELLY RD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5363
Mailing Address - Country:US
Mailing Address - Phone:601-799-4065
Mailing Address - Fax:601-799-4064
Practice Address - Street 1:621 W CANAL ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3916
Practice Address - Country:US
Practice Address - Phone:601-889-9800
Practice Address - Fax:601-889-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02020221Medicaid