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General NPI Number Information
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NPI Number | 1831579507
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Entity Type | Organization
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Legal Business Name | LAUNCH
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 365 HATCHELL LN.
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726
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Country | US
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Telephone | 225-238-1741
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Fax | 225-341-8749
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Provider Business Mailing Address
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Address Line | PO BOX 2345
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City | DENHAM SPRINGS
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State | LA
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Zip | 70727-2345
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Country | US
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Telephone | 225-238-1741
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Fax | 225-341-8749
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CHANTELLE BALLARD VARNADO
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Credential | PHD, CCC-SLP
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Telephone | 225-405-8627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4777
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License Number State | LA
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