| Doctor Name: | MIA JAQUAY KIMMONS |
| NPI Number: | 1922286863 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. CCC-SLP |
| License Number: | 3231 |
| Business Practice Address: | 7145 Swinnea Road Suite # 1 Southaven, MS - 386716013 |
| Business Phone Number: | 6623492370 |
| Business Fax Number: | 6623492384 |
| Mailing Address: | Po Box 552, SOUTHAVEN |
| State: | MS |
| Postal Code: | 386710006 |
| Phone Number: | 6623492370 |
| Fax Number: | 6623492384 |
| NPI Enumeration Date: | 02/01/2008 |
| NPI Last Update Date: | 11/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3231 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| 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 |