Provider Demographics
NPI:1487338455
Name:COASTAL SPEECH, LANGUAGE, AND LITERACY, LLC
Entity type:Organization
Organization Name:COASTAL SPEECH, LANGUAGE, AND LITERACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC - SLP
Authorized Official - Phone:228-218-3362
Mailing Address - Street 1:20250 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6430
Mailing Address - Country:US
Mailing Address - Phone:228-218-3362
Mailing Address - Fax:228-366-9062
Practice Address - Street 1:4214 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5975
Practice Address - Country:US
Practice Address - Phone:228-218-3362
Practice Address - Fax:228-366-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech