Basic Information
| Provider Information | |||||||||
| NPI: | 1528201571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EASTERLING | ||||||||
| FirstName: | CORA | ||||||||
| MiddleName: | MELISSA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 NORTHTOWN DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392113047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012069195 | ||||||||
| FaxNumber: | 8886886877 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 MAGNOLIA DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391536011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017829100 | ||||||||
| FaxNumber: | 6017829100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2009 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2381 | AL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | S3424 | MS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.