Doctor Name: | MRS. FREDDY G TISDALE |
NPI Number: | 1023109808 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA CCCSLP |
License Number: | 4135 |
Business Practice Address: | 255 W Florida St Suite 200 Jefferson Speech & Language Center Of St Tamm Mandeville, LA - 70448 |
Business Phone Number: | 9856268403 |
Business Fax Number: | 9857279871 |
Mailing Address: | 255 W Florida St, Suite 200 Jefferson Speech & Language Center Of St Tamm MANDEVILLE |
State: | LA |
Postal Code: | 70448 |
Phone Number: | 9856268403 |
Fax Number: | 9857279871 |
NPI Enumeration Date: | 09/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4135 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
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 |