Healthcare Provider Details

I. General information

NPI: 1841321148
Provider Name (Legal Business Name): MRS. JUDY LANE CARAWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDY LANE CARAWAY CCC-SLP

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18095 BRANDON DR E
HAMMOND LA
70403-0271
US

IV. Provider business mailing address

18095 BRANDON DR E
HAMMOND LA
70403-0271
US

V. Phone/Fax

Practice location:
  • Phone: 985-340-2925
  • Fax:
Mailing address:
  • Phone: 985-340-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4500
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS2361
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: