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NPI Code Detail

MEDICARE: MRS. EMILY BASS WYATT ST

MEDICARE: MRS. EMILY BASS WYATT ST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist6558146LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336278936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMILY BASS WYATT ST
Provider Business Mailing Address
First Line : 2606 BELOIT ST
Second Line :
City : MONROE
State : LA
Zip : 71201-2515
Country : US
Telephone Number : 318-680-1618
Fax Number : 318-329-3666
Provider Business Practice Location Address
First Line : 901 N 4TH ST
Second Line :
City : MONROE
State : LA
Zip : 71201-5909
Country : US
Telephone Number : 318-387-7817
Fax Number : 318-322-0914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 01/11/2022

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Directions to “ MRS. EMILY BASS WYATT ST” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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