Provider Demographics
NPI:1952527467
Name:THE UNIVERSITY OF MISSISSIPPI SPEECH AND HEARING CENTER
Entity Type:Organization
Organization Name:THE UNIVERSITY OF MISSISSIPPI SPEECH AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:LENNETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, PHD
Authorized Official - Phone:662-915-7271
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY
Mailing Address - State:MS
Mailing Address - Zip Code:38677-1848
Mailing Address - Country:US
Mailing Address - Phone:662-915-7271
Mailing Address - Fax:662-915-7263
Practice Address - Street 1:2301 SOUTH LAMAR BOULEVARD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-915-7271
Practice Address - Fax:662-915-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00075200Medicaid