Doctor Name: | BRETT ROUSSELL |
NPI Number: | 1043675689 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 7501 |
Business Practice Address: | 2309 S Service Rd W Ruston, LA - 712703167 |
Business Phone Number: | 3182321969 |
Business Fax Number: | 3182321970 |
Mailing Address: | 2309 S Service Rd W, RUSTON |
State: | LA |
Postal Code: | 712703167 |
Phone Number: | 3182321969 |
Fax Number: | 3182321970 |
NPI Enumeration Date: | 12/28/2015 |
NPI Last Update Date: | 12/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
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 |