Healthcare Provider Details

I. General information

NPI: 1922874940
Provider Name (Legal Business Name): EDUCATIONAL DIAGNOSTIC SERVICES & CONSULTING OF LA., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 LOBDELL BOULEVARD
BATON ROUGE LA
70806
US

IV. Provider business mailing address

1023 LOBDELL BOULEVARD
BATON ROUGE LA
70806
US

V. Phone/Fax

Practice location:
  • Phone: 225-445-7080
  • Fax:
Mailing address:
  • Phone: 225-445-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUMMER STEWART WHITMORE
Title or Position: DIRECTOR
Credential:
Phone: 225-445-7080