Healthcare Provider Details

I. General information

NPI: 1437819877
Provider Name (Legal Business Name): BAYLEA OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CIRCLE DR
WEST MONROE LA
71291-5305
US

IV. Provider business mailing address

205 CIRCLE DR
WEST MONROE LA
71291-5305
US

V. Phone/Fax

Practice location:
  • Phone: 318-381-8520
  • Fax: 888-616-5693
Mailing address:
  • Phone: 318-381-8520
  • Fax: 888-616-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8558
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: