Healthcare Provider Details

I. General information

NPI: 1912676420
Provider Name (Legal Business Name): LEXI SONNIER DEROUEN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 ALBERTSON PKWY
BROUSSARD LA
70518-4971
US

IV. Provider business mailing address

104 PLACIDE DR
LAFAYETTE LA
70508-1606
US

V. Phone/Fax

Practice location:
  • Phone: 337-839-9005
  • Fax:
Mailing address:
  • Phone: 337-277-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8150
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: