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General NPI Number Information
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NPI Number | 1447445259
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Entity Type | Individual
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Provider Name | STACIE MARIE PROVOSTY M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 3419 SAINT CLAUDE AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70117-6144
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Country | US
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Telephone | 504-330-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 2833 JOSEPH ST
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City | NEW ORLEANS
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State | LA
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Zip | 70115-7043
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Country | US
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Telephone | 504-864-8311
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Fax | 504-864-8311
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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 | 5819
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8000
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License Number State | OH
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