MEDICARE: THRIVE NEURO WELLNESS

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

General Provider Information

NPI Number	:	1538099304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE NEURO WELLNESS

Provider Business Mailing Address
First Line	:	67156 LOCKE ST
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-6910
Country	:	US
Telephone Number	:	504-343-7052
Fax Number	:

Provider Business Practice Location Address
First Line	:	67156 LOCKE ST
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-6910
Country	:	US
Telephone Number	:	504-343-7052
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST/OWNER
Name	:	DANA MCKINNEY
Credential	:
Telephone Number	:	504-343-7052

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “THRIVE NEURO WELLNESS ” Practice Location

Language	Start Address	Practice Location

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