=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790063436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHATTERNOLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2011
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 N CAUSEWAY BLVD
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-1746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-250-6422
-----------------------------------------------------
Fax | 985-652-5178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 RIDGELAKE DR STE 102
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-4946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-354-8078
-----------------------------------------------------
Fax | 504-354-1437
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASHLEY SCOTT
-----------------------------------------------------
Credential | M.S., SLP, BCBA
-----------------------------------------------------
Telephone | 504-250-6422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | 5960
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 5687
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------