Basic Information
| Provider Information | |||||||||
| NPI: | 1669499646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIESE | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | S.L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1532 FOUNDERS DR | ||||||||
| Address2: | |||||||||
| City: | BOGALUSA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704274058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857323727 | ||||||||
| FaxNumber: | 9857306709 | ||||||||
| Practice Location | |||||||||
| Address1: | 433 PLAZA ST | ||||||||
| Address2: | |||||||||
| City: | BOGALUSA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704273729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857306705 | ||||||||
| FaxNumber: | 9857307183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 486 | LA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 486 | 01 | LA | SPEECH-LANGUAGE PATHOLOGY | OTHER |