Provider Demographics
NPI:1386816700
Name:KEY THERAPY, PLLC
Entity Type:Organization
Organization Name:KEY THERAPY, PLLC
Other - Org Name:KEYS TO COMMUNICATION SPEECH, LANGUAGE & LEARNING CENTER, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:662-349-2370
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0006
Mailing Address - Country:US
Mailing Address - Phone:662-349-2370
Mailing Address - Fax:662-349-2384
Practice Address - Street 1:7145 SWINNEA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6380
Practice Address - Country:US
Practice Address - Phone:662-349-2370
Practice Address - Fax:662-349-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty