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General NPI Number Information
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NPI Number | 1053327395
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Entity Type | Individual
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Provider Name | MAURA CARMOUCHE MIZE M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1130 PITHON ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5245
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Country | US
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Telephone | 337-433-4212
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Fax | 337-433-4234
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Provider Business Mailing Address
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Address Line | 1130 PITHON ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5245
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Country | US
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Telephone | 337-433-4212
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Fax | 337-433-4234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1075
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License Number State | LA
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