=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427697283
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDWOOD SPEECH AND FEEDING SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2019
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 LA RUE FRANCE STE 108
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-242-7931
-----------------------------------------------------
Fax | 337-282-8015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 LA RUE FRANCE STE 108
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-242-7931
-----------------------------------------------------
Fax | 337-282-8015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASHLEY PILON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-269-6990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------