Healthcare Provider Details

I. General information

NPI: 1447886817
Provider Name (Legal Business Name): HAYLEY SHOOK KENNEDY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GUILLOT RD
YOUNGSVILLE LA
70592-5832
US

IV. Provider business mailing address

PO BOX 23
YOUNGSVILLE LA
70592-0023
US

V. Phone/Fax

Practice location:
  • Phone: 337-856-1964
  • Fax: 337-856-5272
Mailing address:
  • Phone: 337-856-1964
  • Fax: 337-856-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7949
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: