Healthcare Provider Details

I. General information

NPI: 1982980280
Provider Name (Legal Business Name): MARY P APPLEBY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

IV. Provider business mailing address

1619 LISBON ST
NEW ORLEANS LA
70122-2818
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8666
  • Fax:
Mailing address:
  • Phone: 504-218-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1559
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: