Provider Demographics
NPI:1487766119
Name:PRICE, MISCHA L (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MISCHA
Middle Name:L
Last Name:PRICE
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 1:2465 ROCKY HILL DEDEAUX RD
Mailing Address - Street 2:
Mailing Address - City:KILN
Mailing Address - State:MS
Mailing Address - Zip Code:39556-6552
Mailing Address - Country:US
Mailing Address - Phone:251-895-3183
Mailing Address - Fax:
Practice Address - Street 1:2465 ROCKY HILL DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:KILN
Practice Address - State:MS
Practice Address - Zip Code:39556-6552
Practice Address - Country:US
Practice Address - Phone:251-895-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2114235Z00000X
MSS-3407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist