Provider Demographics
NPI:1427204437
Name:MIDDLETON, JEAN S (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:S
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MORNING GLORY CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-8411
Mailing Address - Country:US
Mailing Address - Phone:662-231-3220
Mailing Address - Fax:662-869-7153
Practice Address - Street 1:235 COUNTY ROAD 251
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-8755
Practice Address - Country:US
Practice Address - Phone:662-231-3220
Practice Address - Fax:662-869-7153
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist