Healthcare Provider Details

I. General information

NPI: 1376530741
Provider Name (Legal Business Name): MEHER H. BANAJEE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MADERA CT
KENNER LA
70065-3140
US

IV. Provider business mailing address

27 MADERA CT
KENNER LA
70065-3140
US

V. Phone/Fax

Practice location:
  • Phone: 504-450-6264
  • Fax:
Mailing address:
  • Phone: 504-450-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2216
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: