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General NPI Number Information
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NPI Number | 1093229460
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Entity Type | Individual
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Provider Name | ASA PAUL WARREN ,M.S., CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 1961 MIDWAY ST
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City | SHREVEPORT
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State | LA
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Zip | 71108-2200
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Country | US
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Telephone | 318-603-6831
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Fax |
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Provider Business Mailing Address
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Address Line | 304 HARDERS CROSSING BLVD
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City | SHREVEPORT
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State | LA
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Zip | 71106-8557
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Country | US
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Telephone | 318-455-8227
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Fax |
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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 | 7589
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License Number State | LA
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