Healthcare Provider Details

I. General information

NPI: 1043962723
Provider Name (Legal Business Name): RIAH BROOKE EYRE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 E 70TH ST
SHREVEPORT LA
71105-4002
US

IV. Provider business mailing address

305 GLEN ELLEN DR
PINEVILLE LA
71360-4439
US

V. Phone/Fax

Practice location:
  • Phone: 318-795-3388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8611
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: