Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ellisville State School

Organization Technician · NPI 1164582821

Ellisville State School is a Technician in Ellisville, Mississippi. Licensed in Mississippi. Registered with an NPI since 2006.

Licensed in
MS
In the registry since
2006

Practice location Address checks out

1101 Highway 11 S
Ellisville, MS 39437-4443
Phone: (601) 477-9384
Fax: (601) 477-5700
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Technician (primary) Taxonomy 374700000X · Licence ESS-BMR (MS)

Record details

NPI number1164582821
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Suzie Lassiter — Director Of Facility · (601) 477-9384
Other names Epsdt
NPI enumeratedDecember 11, 2006
Last updated in NPPESJune 17, 2008
Mailing address1101 Highway 11 S, Ellisville, MS 39437-4443