Provider Demographics
NPI:1417434986
Name:JUBILEE THERAPY, LLC
Entity Type:Organization
Organization Name:JUBILEE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOTARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:601-852-3271
Mailing Address - Street 1:916 BELMONT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3830
Mailing Address - Country:US
Mailing Address - Phone:817-946-0773
Mailing Address - Fax:
Practice Address - Street 1:916 BELMONT ST STE 1
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3830
Practice Address - Country:US
Practice Address - Phone:817-946-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02788783Medicaid