Healthcare Provider Details

I. General information

NPI: 1538071006
Provider Name (Legal Business Name): AVA PRUDHOMME ROY M.A., L-SLP, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVA PRUDHOMME M.A., L-SLP, CCC-SLP

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 DONAHUE FERRY RD
PINEVILLE LA
71360-4434
US

IV. Provider business mailing address

220 CEDAR LN
MARKSVILLE LA
71351-4002
US

V. Phone/Fax

Practice location:
  • Phone: 318-691-0898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9504
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: