Healthcare Provider Details

I. General information

NPI: 1114516218
Provider Name (Legal Business Name): SPEECH BUBBLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 SOUTHAVEN LN
SHREVEPORT LA
71106-8390
US

IV. Provider business mailing address

490 SOUTHAVEN LN
SHREVEPORT LA
71106-8390
US

V. Phone/Fax

Practice location:
  • Phone: 318-518-0778
  • Fax:
Mailing address:
  • Phone: 318-518-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MEGAN VAUGHN LERCHIE
Title or Position: OWNER/SPEECH-LANGUAGE PATHOLOGIST
Credential: MCD/CCC-SLP
Phone: 318-518-0778