MEDICARE: LAURA LEBLANC M.C.D-SLP, CCC

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	6696	LA
2	235Z00000X	Speech-Language Pathologist	109820	TX

General Provider Information

NPI Number	:	1851769566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LEBLANC M.C.D-SLP, CCC

Provider Business Mailing Address
First Line	:	308 BROADWAY ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-3512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 BROADWAY ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-3512
Country	:	US
Telephone Number	:	337-298-6563
Fax Number	:

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

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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