Healthcare Provider Details

I. General information

NPI: 1962316109
Provider Name (Legal Business Name): HAILEY BERGERON LEONARD MS, L-SLP, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LAFAYETTE WOODS BLVD
HOUMA LA
70363-3866
US

IV. Provider business mailing address

270 PEARL MARGARET DR
GRAY LA
70359-4526
US

V. Phone/Fax

Practice location:
  • Phone: 985-303-4839
  • Fax:
Mailing address:
  • Phone: 985-413-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10016
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: