NPIMap

Organization Active NPI

Speech Language Pathology

  • Speech-Language Pathologist
  • Brandon, MS
National Provider Identifier
1467671990
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
S0692 Issued in MS
Legal business name
SPEECH LANGUAGE PATHOLOGY
Practice address
1929 Spillway Rd Ste a
Brandon, MS 39047-6079
Phone
(601) 992-5370
Fax
(601) 992-5370
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jeffalyn Trammell, M.S.,C.C.C.
Title
Director President
Phone
(601) 992-5370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X S0692 MS Primary

Addresses

Primary practice location

1929 Spillway Rd Ste a
Brandon, MS 39047-6079

Mailing address

1929 Spillway Rd Ste a
Brandon, MS 39047-6079
Phone (601) 992-5370

Other identifiers 1

IdentifierTypeStateIssuer
09016147MedicaidMS

National Provider Directory

National Provider Directory

Locations

1929 Spillway Rd
Ste A
Brandon, MS 39047
Phone (601) 992-5370

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467671990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1929 SPILLWAY RD STE A",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476079",
            "telephone_number": "601-992-5370",
            "fax_number": "601-992-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1929 SPILLWAY RD STE A",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476079",
            "telephone_number": "601-992-5370",
            "fax_number": "601-992-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEECH LANGUAGE PATHOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRAMMELL",
        "authorized_official_first_name": "JEFFALYN",
        "authorized_official_title_or_position": "DIRECTOR PRESIDENT",
        "authorized_official_telephone_number": "601-992-5370",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S.,C.C.C."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S0692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016147",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.