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General NPI Number Information
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NPI Number | 1437480886
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Entity Type | Organization
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Legal Business Name | SPEECH CARE CLINIC
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 8870 YOUREE DR STE 210
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City | SHREVEPORT
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State | LA
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Zip | 71115-2512
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Country | US
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Telephone | 318-798-2981
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Fax | 318-798-0447
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Provider Business Mailing Address
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Address Line | 809 ONEONTA ST
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City | SHREVEPORT
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State | LA
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Zip | 71106-1129
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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 | PRESIDENT
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Name | JUDY RELLER
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Credential | CCC-SLP
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Telephone | 318-422-5460
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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 | 2709
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License Number State | LA
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