Provider Demographics
NPI:1740370782
Name:TUCCIO, MISTY S (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:S
Last Name:TUCCIO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:55 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4782
Mailing Address - Country:US
Mailing Address - Phone:601-446-8764
Mailing Address - Fax:601-446-8745
Practice Address - Street 1:55 SGT PRENTISS DR
Practice Address - Street 2:SUITE 8
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4782
Practice Address - Country:US
Practice Address - Phone:601-446-8764
Practice Address - Fax:601-446-8745
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126221Medicaid