Healthcare Provider Details

I. General information

NPI: 1609345123
Provider Name (Legal Business Name): EMILY MAE MAURIN MA, L-SLP, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13855 RIVER RD
LULING LA
70070-6220
US

IV. Provider business mailing address

21 SHADOW LN
DESTREHAN LA
70047-3624
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-6289
  • Fax:
Mailing address:
  • Phone: 504-609-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9155
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: