Basic Information
| Provider Information | |||||||||
| NPI: | 1841321924 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDIATRIC SPEECH AND LANGUAGE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9029 REDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705102173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378931501 | ||||||||
| FaxNumber: | 3378936607 | ||||||||
| Practice Location | |||||||||
| Address1: | 9029 REDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | ABBEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705102173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378931501 | ||||||||
| FaxNumber: | 3378936607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEGOULLON | ||||||||
| AuthorizedOfficialFirstName: | MARSHA | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3378931501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | PROF. | ||||||||
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| AuthorizedOfficialCredential: | SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 4980 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.