Healthcare Provider Details

I. General information

NPI: 1184369209
Provider Name (Legal Business Name): AIDEN GENOVESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N THEARD ST
COVINGTON LA
70433-2835
US

IV. Provider business mailing address

42283 JOSHUA DR
PONCHATOULA LA
70454-8716
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-2276
  • Fax:
Mailing address:
  • Phone: 985-640-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8452
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: