Provider Demographics
NPI:1609147917
Name:USM DUBARD SCHOOL FOR LANGUAGE DISORDERS
Entity Type:Organization
Organization Name:USM DUBARD SCHOOL FOR LANGUAGE DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AISSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-266-5223
Mailing Address - Street 1:KAY JAMES DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406-0001
Mailing Address - Country:US
Mailing Address - Phone:601-266-5223
Mailing Address - Fax:601-266-6763
Practice Address - Street 1:KAY JAMES DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0001
Practice Address - Country:US
Practice Address - Phone:601-266-5223
Practice Address - Fax:601-266-6763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF SOUTHERN MISSISSIPPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)