Provider Demographics
NPI:1588151005
Name:FARRISH, PAULISHA TRENISE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PAULISHA
Middle Name:TRENISE
Last Name:FARRISH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GRAY DR
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2828
Mailing Address - Country:US
Mailing Address - Phone:601-946-1450
Mailing Address - Fax:
Practice Address - Street 1:6316 LYNDON B JOHNSON DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-2921
Practice Address - Country:US
Practice Address - Phone:601-850-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist