Basic Information
Provider Information | |||||||||
NPI: | 1700326915 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SELMAN | ||||||||
FirstName: | ANN | ||||||||
MiddleName: | TURNER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PENTECOST | ||||||||
OtherFirstName: | ANN | ||||||||
OtherMiddleName: | TURNER | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2416 HIGHWAY 45 N | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | MS | ||||||||
PostalCode: | 397051320 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6623276705 | ||||||||
FaxNumber: | 6623276760 | ||||||||
Practice Location | |||||||||
Address1: | 1201 HIGHWAY 49 S | ||||||||
Address2: | SUITE 2 | ||||||||
City: | RICHLAND | ||||||||
State: | MS | ||||||||
PostalCode: | 392189425 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7692338844 | ||||||||
FaxNumber: | 7692511825 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/07/2017 | ||||||||
LastUpdateDate: | 01/06/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/06/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 53789 | MS | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.