=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548561178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARA LEIGH SOILEAU SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2010
-----------------------------------------------------
Last Update Date | 12/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 342 ST. THERESA AVENUE
-----------------------------------------------------
City | VILLE PLATTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-240-4655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 342 SAINT THERESA AVE
-----------------------------------------------------
City | VILLE PLATTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70586-3612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-240-4655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 12072484
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------