| Doctor Name: | DR. LENNETTE JOHNSON IVY |
| NPI Number: | 1558647644 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCC-SLP, PH.D. |
| License Number: | S0583 |
| Business Practice Address: | 302 George Hall, Rebel Dr. University, MS - 386779700 |
| Business Phone Number: | 6629155130 |
| Business Fax Number: | 6629155717 |
| Mailing Address: | 302 George Hall, Rebel Dr., UNIVERSITY |
| State: | MS |
| Postal Code: | 38677 |
| Phone Number: | 6629155130 |
| Fax Number: | 6629155717 |
| NPI Enumeration Date: | 11/02/2011 |
| NPI Last Update Date: | 11/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | S0583 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |