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General NPI Number Information
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NPI Number | 1164957874
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Entity Type | Organization
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Legal Business Name | SOUTHERN SPEECH, LLC
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 239 THIBODEAUX DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-4441
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Country | US
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Telephone | 337-298-3176
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Fax |
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Provider Business Mailing Address
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Address Line | 239 THIBODEAUX DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-4441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | COURTNEY PRINCE BACK
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Credential | MCD, SLP-CCC
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Telephone | 337-298-3176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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