Provider Demographics
NPI:1972874485
Name:MCREYNOLDS, DORIS ELIZABETH
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:ELIZABETH
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LIBBY
Other - Middle Name:CARNATHAN
Other - Last Name:MCREYNOLDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:202A CROSSGATE ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9660
Mailing Address - Country:US
Mailing Address - Phone:662-338-5141
Mailing Address - Fax:
Practice Address - Street 1:1001 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2125
Practice Address - Country:US
Practice Address - Phone:662-323-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist