Healthcare Provider Details

I. General information

NPI: 1184112658
Provider Name (Legal Business Name): LOUISIANA TECH SPEECH AND HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W ALABAMA AVE STE 101
RUSTON LA
71270-4231
US

IV. Provider business mailing address

PO BOX 3165
RUSTON LA
71272-0001
US

V. Phone/Fax

Practice location:
  • Phone: 318-257-2438
  • Fax: 318-257-5986
Mailing address:
  • Phone: 318-257-4764
  • Fax: 318-257-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number5681
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number5555
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2197
License Number StateLA

VIII. Authorized Official

Name: DR. BRENDA HEIMAN
Title or Position: HEAD
Credential: PH.D.
Phone: 318-257-4764