Provider Demographics
NPI:1285752725
Name:MSL SUPPORT SERVICES INC
Entity type:Organization
Organization Name:MSL SUPPORT SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LONGMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:601-693-0948
Mailing Address - Street 1:2208 41ST STREET
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-3321
Mailing Address - Country:US
Mailing Address - Phone:601-693-0948
Mailing Address - Fax:601-693-2494
Practice Address - Street 1:2208 41ST STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-3321
Practice Address - Country:US
Practice Address - Phone:601-693-0948
Practice Address - Fax:601-693-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS587361125OtherBCBS