Organization Name: | THE SPEECH PATHOLOGY CENTER OF LOUISIANA, LLC |
NPI Number: | 1164591038 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MONDRA ROSE FAZELY (MEMBER) |
Mailing Address: | 8676 Goodwood Blvd Suite 204 Baton Rouge |
State: | LA US |
Postal Code: | 708067914 |
Phone Number: | 2259231140 |
Fax Number: | 2259231326 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2002 |
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 |