Heather Ezell
Individual provider Active NPI Speech-Language Pathologist · Petal, MS
NPI 1245049154 · NPPES record last updated Jan 6, 2025
Key facts
- NPI
- 1245049154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- S-4734 (MS)
- Practice address
- 53 Redfern TRL
Petal, MS 39465-2672 - Phone
- (601) 520-2352
- NPI assigned
- Jan 6, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S-4734 | MS | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Speak Up Therapy, LLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist |
235Z00000X | S-4734 | MS | Yes |
Addresses
Primary practice location
53 Redfern TRL
Petal, MS 39465-2672
Mailing address
53 Redfern TRL
Petal, MS 39465-2672
Phone (601) 520-2352
Other providers in Petal, MS
- Taryn Dyess
- Lesley Thomas Ellison
- Encore Rehabilitation Inc
- April L Estill
- Anthony Lee Evans
- Phillip Matthew Ezell
- Lorelei Lucas Farr
- Marcus Donald Finch
- Fit Jam LLC
- William Phillip Fortenberry Jr.
All providers in Petal, MS · Speech-Language Pathologist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.