| NPI | 1164591038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONDRA ROSE FAZELY Member 225-923-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: LA 2002) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |