Provider Demographics
NPI:1720314339
Name:JUMPER, LAWANNA L (SLP)
Entity Type:Individual
Prefix:
First Name:LAWANNA
Middle Name:L
Last Name:JUMPER
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 1:185 HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-6001
Mailing Address - Country:US
Mailing Address - Phone:601-795-4736
Mailing Address - Fax:601-403-8162
Practice Address - Street 1:302 S JULIA ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-2818
Practice Address - Country:US
Practice Address - Phone:601-795-4736
Practice Address - Fax:601-403-8162
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist