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General NPI Number Information
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NPI Number | 1861698094
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Entity Type | Organization
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Legal Business Name | THE SPEECH LADY
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 JORDAN RD
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City | WEST MONROE
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State | LA
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Zip | 71291-1615
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Country | US
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Telephone | 318-614-7400
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Fax | 318-410-4351
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Provider Business Mailing Address
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Address Line | 121 JORDAN RD
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City | WEST MONROE
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State | LA
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Zip | 71291-1615
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Country | US
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Telephone | 318-614-7400
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Fax | 318-410-4351
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Authorized Official
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Title or Position | OWNER
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Name | JOELLEN FREEMAN
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Credential | MA-CCC-SLP
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Telephone | 318-614-7400
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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 | 3462
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License Number State | LA
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