| Doctor Name: | MS. MONDRA ROSE FAZELY |
| NPI Number: | 1316016181 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., CCC-SLP |
| License Number: | 2002 |
| Business Practice Address: | 8676 Goodwood Blvd Suite 204 Baton Rouge, LA - 708067914 |
| Business Phone Number: | 2259231140 |
| Business Fax Number: | 2259231326 |
| Mailing Address: | 637 Carriage Way, BATON ROUGE |
| State: | LA |
| Postal Code: | 708084832 |
| Phone Number: | 2257697479 |
| 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 |