Basic Information
| Provider Information | |||||||||
| NPI: | 1598353799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESLEY | ||||||||
| FirstName: | ANESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 HACKETT DR | ||||||||
| Address2: | |||||||||
| City: | MINDEN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710552224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185845473 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2522 E 70TH ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711054002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187953388 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2021 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8710 | LA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.