Provider Demographics
NPI:1538519830
Name:PREMIER SPEECH THERAPY
Entity Type:Organization
Organization Name:PREMIER SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-487-8442
Mailing Address - Street 1:213 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4617
Mailing Address - Country:US
Mailing Address - Phone:601-487-8442
Mailing Address - Fax:601-487-8042
Practice Address - Street 1:213 ALLEN DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-4617
Practice Address - Country:US
Practice Address - Phone:601-487-8442
Practice Address - Fax:601-487-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health