Provider Demographics
NPI:1013710631
Name:GRACEFUL TALK SPEECH-LANGUAGE PATHOLOGY SERVICES
Entity type:Organization
Organization Name:GRACEFUL TALK SPEECH-LANGUAGE PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-850-1172
Mailing Address - Street 1:201 MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-3435
Mailing Address - Country:US
Mailing Address - Phone:601-850-1172
Mailing Address - Fax:
Practice Address - Street 1:160 GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-3106
Practice Address - Country:US
Practice Address - Phone:601-850-1172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty