MEDICARE: MILDRED ELIZABETH HYDE MS CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SLP7099	NM
2	235Z00000X	Speech-Language Pathologist	3327	OK
3	235Z00000X	Speech-Language Pathologist	8978	LA

General Provider Information

NPI Number	:	1528254489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED ELIZABETH HYDE MS CCC-SLP

Provider Business Mailing Address
First Line	:	1714 WOLF CIR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2353
Country	:	US
Telephone Number	:	337-508-2505
Fax Number	:	337-508-2506

Provider Business Practice Location Address
First Line	:	1714 WOLF CIR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2353
Country	:	US
Telephone Number	:	337-508-2505
Fax Number	:	337-508-2506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	06/27/2023

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