Healthcare Provider Details

I. General information

NPI: 1407770217
Provider Name (Legal Business Name): JAYDEN BERTHELOT M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18268 PETROLEUM DR
BATON ROUGE LA
70809-6126
US

IV. Provider business mailing address

17732 HIGHLAND RD. STE G, BOX 243
BATON ROUGE LA
70810
US

V. Phone/Fax

Practice location:
  • Phone: 225-292-4138
  • Fax: 225-636-2940
Mailing address:
  • Phone: 225-292-4138
  • Fax: 225-636-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9683
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: