Provider Demographics
NPI:1528201571
Name:EASTERLING, CORA MELISSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CORA
Middle Name:MELISSA
Last Name:EASTERLING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:13 NORTHTOWN DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3047
Mailing Address - Country:US
Mailing Address - Phone:601-206-9195
Mailing Address - Fax:888-688-6877
Practice Address - Street 1:309 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6011
Practice Address - Country:US
Practice Address - Phone:601-782-9100
Practice Address - Fax:601-782-9100
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL2381235Z00000X
MSS3424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist